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Hoang Dong N, Audrey L, Leopold MN, Javier M, Hugues A, Luigi B, Gilles B, Scott MS, Sophie R. Osteoclast microRNA Profiling in Rheumatoid Arthritis to Capture the Erosive Factor. JBMR Plus 2023; 7:e10776. [PMID: 37614303 PMCID: PMC10443079 DOI: 10.1002/jbm4.10776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 08/25/2023] Open
Abstract
In rheumatoid arthritis (RA), only a subset of patients develop irreversible bone destruction. Our aim was to identify a microRNA (miR)-based osteoclast-related signature predictive of erosiveness in RA. Seventy-six adults with erosive (E) or nonerosive (NE) seropositive RA and 43 sex- and age-matched healthy controls were recruited. Twenty-five miRs from peripheral blood mononuclear cell (PBMC)-derived osteoclasts selected from RNA-Seq (discovery cohort) were assessed by qPCR (replication cohort), as were 33 target genes (direct targets or associated with regulated pathways). The top five miRs found differentially expressed in RA osteoclasts were either decreased (hsa-miR-34a-3p, 365b-3p, 374a-3p, and 511-3p [E versus NE]) or increased (hsa-miR-193b-3p [E versus controls]). In vitro, inhibition of miR-34a-3p had an impact on osteoclast bone resorption. An integrative network analysis of miRs and their targets highlighted correlations between mRNA and miR expression, both negative (CD38, CD80, SIRT1) and positive (MITF), and differential gene expression between NE versus E (GXYLT1, MITF) or versus controls (CD38, KLF4). Machine-learning models were used to evaluate the value of miRs and target genes, in combination with clinical data, to predict erosion. One model, including a set of miRs (predominantly 365b-3p) combined with rheumatoid factor titer, provided 70% accuracy (area under the curve [AUC] 0.66). Adding genes directly targeted or belonging to related pathways improved the predictive power of the model for the erosive phenotype (78% accuracy, AUC 0.85). This proof-of-concept study indicates that identification of RA subjects at risk of erosions may be improved by studying miR expression in PBMC-derived osteoclasts, suggesting novel approaches toward personalized treatment. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Nguyen Hoang Dong
- Department of Biochemistry and Functional GenomicsUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
| | - Lortie Audrey
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health SciencesUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
| | - Mbous Nguimbus Leopold
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health SciencesUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
| | - Marrugo Javier
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health SciencesUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
| | - Allard‐Chamard Hugues
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health SciencesUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
| | - Bouchard Luigi
- Department of Biochemistry and Functional GenomicsUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
- Department of Medical BiologyCIUSS du Saguenay‐Lac‐Saint‐Jean Hôpital Universitaire de ChicoutimiSaguenayCanada
| | - Boire Gilles
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health SciencesUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
| | - Michelle S Scott
- Department of Biochemistry and Functional GenomicsUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
| | - Roux Sophie
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health SciencesUniversity of Sherbrooke and Research Centre of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie – Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE‐CHUS)SherbrookeCanada
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2
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Vignos PJ, Parker WT, Thompson HM. Evaluation of a Clinic Education Program for Patients with Rheumatoid Arthritis. J Rheumatol 2023; 50:156-165. [PMID: 36587951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/1976] [Accepted: 05/07/1976] [Indexed: 01/03/2023]
Abstract
A group education program was developed for clinic patients with rheumatoid arthritis. Teaching methods used included the Arthritis Foundation's handbook, Rheumatoid Arthritis, and a lecture by a rheumatologist. The 20 patients in the study were given a multiple choice test before and after the teaching program to determine their knowledge of arthritis. Results showed group education to be an effective teaching device. It was demonstrated that patients learned from reading the handbook alone, but the combination of reading and lecture was found to be a more effective method. Correlation studies showed that prior to group education, patients had a significant knowledge of their disease which was related to native intelligence, formal education, and socio-economic status, but not to duration of disease or length of clinic attendance. This suggests that future patient education experiments should include a pre-instuction test to document prior knowledge.
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Affiliation(s)
- Paul J Vignos
- From the Department of Medicine, Case Western Reserve University School of Medicine, and the Lakeside Hospital, Cleveland, Ohio, U.S.A
| | - William T Parker
- From the Department of Medicine, Case Western Reserve University School of Medicine, and the Lakeside Hospital, Cleveland, Ohio, U.S.A
| | - Helen M Thompson
- From the Department of Medicine, Case Western Reserve University School of Medicine, and the Lakeside Hospital, Cleveland, Ohio, U.S.A
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3
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Kasher M, Freidin MB, Williams FM, Cherny SS, Malkin I, Livshits G. Shared Genetic Architecture Between Rheumatoid Arthritis and Varying Osteoporotic Phenotypes. J Bone Miner Res 2022; 37:440-453. [PMID: 34910834 DOI: 10.1002/jbmr.4491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/19/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022]
Abstract
Rheumatoid arthritis (RA) and low bone mineral density (BMD), an indicator of osteoporosis (OP), appear epidemiologically associated. Shared genetic factors may explain this association. This study aimed to investigate the presence of pleiotropy to clarify the potential genetic association between RA and OP. We examined BMDs at varying skeletal sites reported in UK Biobank as well as OP fracture acquired from the Genetic Factors for Osteoporosis (GEFOS) Consortium and the TwinsUK study. PRSice-2 was used to assess the potential shared genetic overlap between RA and OP. The presence of pleiotropy was examined using colocalization analysis. PRSice-2 revealed that RA was significantly associated with OP fracture (β = 351.6 ± 83.9, p value = 2.76E-05), total BMD (β = -1763.5 ± 612.8, p = 4.00E-03), spine BMD (β = -919.8 ± 264.6, p value = 5.09E-04), and forearm BMD (β = -66.09 ± 31.40, p value = 3.53E-02). Through colocalization analysis, the same causal genetic variants, associated with both RA and OP, were apparent in 12 genes: PLCL1, BOLL, AC011997.1, TNFAIP3, RP11-158I9.1, CDK6, CHCHD4P2, RP11-505C13.1, PHF19, TRAF1, C5, and C11orf49 with moderate posterior probabilities (>50%). Pleiotropy is involved in the association between RA and OP phenotypes. These findings contribute to the understanding of disease mechanisms and provide insight into possible therapeutic advancements and enhanced screening measures. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Melody Kasher
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maxim B Freidin
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Frances Mk Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Stacey S Cherny
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ida Malkin
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gregory Livshits
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK.,Adelson Medical School, Ariel University, Ariel, Israel
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4
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Zeng KQ, Gong FY, Pan XH, Miao J, Gong Z, Wang J, Zhong Q, Dai XQ, Gao XM. IgG Immunocomplexes Drive the Differentiation of a Novel Subset of Osteoclasts Independent of RANKL and Inflammatory Cytokines. J Bone Miner Res 2021; 36:1174-1188. [PMID: 33651383 DOI: 10.1002/jbmr.4281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/14/2022]
Abstract
Potentiation of receptor activator of NF-κB ligand (RANKL)-induced osteoclastogenesis by IgG immunocomplexes (ICs) is generally considered an important pathway leading to cartilage and bone destruction in rheumatoid arthritis (RA). However, whether IgG ICs possess pro-osteoclastogenic potential independent of RANKL and inflammatory cytokines is unclear. Here we demonstrate that by fully cross-linking human FcγRIIa (hFcγRIIa) or co-ligating hFcγRIIa and TLR4, IgG ICs alone could drive the differentiation of human blood monocytes into nuclear factor of activated T cells cytoplasmic 1 (NFATc1-negative nonclassical osteoclasts (NOCs). Surprisingly, IgG ICs could also overrule RANKL-induced classical osteoclast (COC) differentiation in vitro. In mouse model of collagen-induced arthritis, hFcγRIIa-transgenic, but not nontransgenic control, mice suffered from cartilage/bone destruction accompanied by the presence of NFATc1- NOCs lining the eroded cartilage surface in affected joints. Our results not only identify a novel subset of IC-induced NOCs but also provide a possible explanation for the uncoupling of FcγR-mediated cartilage destruction from RANKL-related bone erosion in autoinflammatory arthritis. © 2021 American Society for Bone and Mineral Research (ASBMR)..
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Affiliation(s)
- Ke-Qin Zeng
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China.,Department of Rheumatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fang-Yuan Gong
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China.,Key Laboratory of Systemic Biology of Suzhou, Suzhou, China
| | - Xiao-Hua Pan
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China
| | - Jie Miao
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China
| | - Zheng Gong
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China
| | - Jun Wang
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China.,Key Laboratory of Systemic Biology of Suzhou, Suzhou, China
| | - Qiao Zhong
- Department of Laboratory Medicine, Suzhou Municipal Hospital, Suzhou, China
| | - Xia-Qiu Dai
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China.,Key Laboratory of Systemic Biology of Suzhou, Suzhou, China
| | - Xiao-Ming Gao
- Institute of Biology and Medical Sciences, School of Biology and Basic Medical Sciences, Soochow University, Suzhou, China.,Key Laboratory of Systemic Biology of Suzhou, Suzhou, China
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5
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Tikhonova IA, Yang H, Bello S, Salmon A, Robinson S, Hemami MR, Dodman S, Kharechko A, Haigh RC, Jani M, McDonald TJ, Hoyle M. Enzyme-linked immunosorbent assays for monitoring TNF-alpha inhibitors and antibody levels in people with rheumatoid arthritis: a systematic review and economic evaluation. Health Technol Assess 2021; 25:1-248. [PMID: 33555998 DOI: 10.3310/hta25080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis is a chronic autoimmune disease that primarily causes inflammation, pain and stiffness in the joints. People with severe disease may be treated with biological disease-modifying anti-rheumatic drugs, including tumour necrosis factor-α inhibitors, but the efficacy of these drugs is hampered by the presence of anti-drug antibodies. Monitoring the response to these treatments typically involves clinical assessment using response criteria, such as Disease Activity Score in 28 joints or European League Against Rheumatism. Enzyme-linked immunosorbent assays can also be used to measure drug and antibody levels in the blood. These tests may inform whether or not adjustments to treatment are required or help clinicians to understand the reasons for treatment non-response or a loss of response. METHODS Systematic reviews were conducted to identify studies reporting on the clinical effectiveness and cost-effectiveness of using enzyme-linked immunosorbent assays to measure drug and anti-drug antibody levels to monitor the response to tumour necrosis factor-α inhibitors [adalimumab (Humira®; AbbVie, Inc., North Chicago, IL, USA), etanercept (Enbrel®; Pfizer, Inc., New York, NY, USA), infliximab (Remicade®, Merck Sharp & Dohme Limited, Hoddesdon, UK), certolizumab pegol (Cimzia®; UCB Pharma Limited, Slough, UK) and golimumab (Simponi®; Merck Sharp & Dohme Limited)] in people with rheumatoid arthritis who had either achieved treatment target (remission or low disease activity) or shown primary or secondary non-response to treatment. A range of bibliographic databases, including MEDLINE, EMBASE and CENTRAL (Cochrane Central Register of Controlled Trials), were searched from inception to November 2018. The risk of bias was assessed using the Cochrane ROBINS-1 (Risk Of Bias In Non-randomised Studies - of Interventions) tool for non-randomised studies, with adaptations as appropriate. Threshold and cost-utility analyses that were based on a decision tree model were conducted to estimate the economic outcomes of adding therapeutic drug monitoring to standard care. The costs and resource use were considered from the perspective of the NHS and Personal Social Services. No discounting was applied to the costs and effects owing to the short-term time horizon of 18 months that was adopted in the economic analysis. The impact on the results of variations in testing and treatment strategies was explored in numerous clinically plausible sensitivity analyses. RESULTS Two studies were identified: (1) a non-randomised controlled trial, INGEBIO, that compared standard care with therapeutic drug monitoring using Promonitor® assays [Progenika Biopharma SA (a Grifols-Progenika company), Derio, Spain] in Spanish patients receiving adalimumab who had achieved remission or low disease activity; and (2) a historical control study. The economic analyses were informed by INGEBIO. Different outcomes from INGEBIO produced inconsistent results in both threshold and cost-utility analyses. The cost-effectiveness of therapeutic drug monitoring varied, from the intervention being dominant to the incremental cost-effectiveness ratio of £164,009 per quality-adjusted life-year gained. However, when the frequency of testing was assumed to be once per year and the cost of phlebotomy appointments was excluded, therapeutic drug monitoring dominated standard care. LIMITATIONS There is limited relevant research evidence and much uncertainty about the clinical effectiveness and cost-effectiveness of using enzyme-linked immunosorbent assay-based testing for therapeutic drug monitoring in rheumatoid arthritis patients. INGEBIO had serious limitations in relation to the National Institute for Health and Care Excellence scope: only one-third of participants had rheumatoid arthritis, the analyses were mostly not by intention to treat and the follow-up was 18 months only. Moreover, the outcomes might not be generalisable to the NHS. CONCLUSIONS Based on the available evidence, no firm conclusions could be made about the cost-effectiveness of therapeutic drug monitoring in England and Wales. FUTURE WORK Further controlled trials are required to assess the impact of using enzyme-linked immunosorbent assays for monitoring the anti-tumour necrosis factors in people with rheumatoid arthritis. STUDY REGISTRATION This study is registered as PROSPERO CRD42018105195. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Irina A Tikhonova
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK.,Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Huiqin Yang
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Segun Bello
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Andrew Salmon
- Peninsula Collaboration for Health Operational Research and Development, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Mohsen Rezaei Hemami
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Sophie Dodman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Andriy Kharechko
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | | | - Meghna Jani
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, UK
| | - Timothy J McDonald
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,University of Exeter Medical School, Exeter, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
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Hewlett S, Almeida C, Ambler N, Blair PS, Choy E, Dures E, Hammond A, Hollingworth W, Kadir B, Kirwan J, Plummer Z, Rooke C, Thorn J, Turner N, Pollock J. Group cognitive-behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technol Assess 2020; 23:1-130. [PMID: 31601357 DOI: 10.3310/hta23570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fatigue is a major problem in rheumatoid arthritis (RA). There is evidence for the clinical effectiveness of cognitive-behavioural therapy (CBT) delivered by clinical psychologists, but few rheumatology units have psychologists. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of a group CBT programme for RA fatigue [named RAFT, i.e. Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural (CB) approaches], delivered by the rheumatology team in addition to usual care (intervention), with usual care alone (control); and to evaluate tutors' experiences of the RAFT programme. DESIGN A randomised controlled trial. Central trials unit computerised randomisation in four consecutive cohorts within each of the seven centres. A nested qualitative evaluation was undertaken. SETTING Seven hospital rheumatology units in England and Wales. PARTICIPANTS Adults with RA and fatigue severity of ≥ 6 [out of 10, as measured by the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS)] who had no recent changes in major RA medication/glucocorticoids. INTERVENTIONS RAFT - group CBT programme delivered by rheumatology tutor pairs (nurses/occupational therapists). Usual care - brief discussion of a RA fatigue self-management booklet with the research nurse. MAIN OUTCOME MEASURES Primary - fatigue impact (as measured by the BRAF-NRS) at 26 weeks. Secondary - fatigue severity/coping (as measured by the BRAF-NRS); broader fatigue impact [as measured by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ)]; self-reported clinical status; quality of life; mood; self-efficacy; and satisfaction. All data were collected at weeks 0, 6, 26, 52, 78 and 104. In addition, fatigue data were collected at weeks 10 and 18. The intention-to-treat analysis conducted was blind to treatment allocation, and adjusted for baseline scores and centre. Cost-effectiveness was explored through the intervention and RA-related health and social care costs, allowing the calculation of quality-adjusted life-years (QALYs) with the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Tutor and focus group interviews were analysed using inductive thematic analysis. RESULTS A total of 308 out of 333 patients completed 26 weeks (RAFT, n/N = 156/175; control, n/N = 152/158). At 26 weeks, the mean BRAF-NRS impact was reduced for the RAFT programme (-1.36 units; p < 0.001) and the control interventions (-0.88 units; p < 0.004). Regression analysis showed a difference between treatment arms in favour of the RAFT programme [adjusted mean difference -0.59 units, 95% confidence interval (CI) -1.11 to -0.06 units; p = 0.03, effect size 0.36], and this was sustained over 2 years (-0.49 units, 95% CI -0.83 to -0.14 units; p = 0.01). At 26 weeks, further fatigue differences favoured the RAFT programme (BRAF-MDQ fatigue impact: adjusted mean difference -3.42 units, 95% CI -6.44 to - 0.39 units, p = 0.03; living with fatigue: adjusted mean difference -1.19 units, 95% CI -2.17 to -0.21 units, p = 0.02; and emotional fatigue: adjusted mean difference -0.91 units, 95% CI -1.58 to -0.23 units, p = 0.01), and these fatigue differences were sustained over 2 years. Self-efficacy favoured the RAFT programme at 26 weeks (Rheumatoid Arthritis Self-Efficacy Scale: adjusted mean difference 3.05 units, 95% CI 0.43 to 5.6 units; p = 0.02), as did BRAF-NRS coping over 2 years (adjusted mean difference 0.42 units, 95% CI 0.08 to 0.77 units; p = 0.02). Fatigue severity and other clinical outcomes were not different between trial arms and no harms were reported. Satisfaction with the RAFT programme was high, with 89% of patients scoring ≥ 8 out of 10, compared with 54% of patients in the control arm rating the booklet (p < 0.0001); and 96% of patients and 68% of patients recommending the RAFT programme and the booklet, respectively, to others (p < 0.001). There was no significant difference between arms for total societal costs including the RAFT programme training and delivery (mean difference £434, 95% CI -£389 to £1258), nor QALYs gained (mean difference 0.008, 95% CI -0.008 to 0.023). The probability of the RAFT programme being cost-effective was 28-35% at the National Institute for Health and Care Excellence's thresholds of £20,000-30,000 per QALY. Tutors felt that the RAFT programme's CB approaches challenged their usual problem-solving style, helped patients make life changes and improved tutors' wider clinical practice. LIMITATIONS Primary outcome data were missing for 25 patients; the EQ-5D-5L might not capture fatigue change; and 30% of the 2-year economic data were missing. CONCLUSIONS The RAFT programme improves RA fatigue impact beyond usual care alone; this was sustained for 2 years with high patient satisfaction, enhanced team skills and no harms. The RAFT programme is < 50% likely to be cost-effective; however, NHS costs were similar between treatment arms. FUTURE WORK Given the paucity of RA fatigue interventions, rheumatology teams might investigate the pragmatic implementation of the RAFT programme, which is low cost. TRIAL REGISTRATION Current Controlled Trials ISRCTN52709998. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 57. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Hewlett
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Celia Almeida
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | | | - Peter S Blair
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Ernest Choy
- Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Emma Dures
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Alison Hammond
- Centre for Health Sciences Research, School of Health Sciences, University of Salford, Salford, UK
| | | | - Bryar Kadir
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - John Kirwan
- Academic Rheumatology, Department of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Zoe Plummer
- Department of Nursing and Midwifery, University of the West of England Bristol, Bristol, UK
| | - Clive Rooke
- Patient Research Partner, Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Joanna Thorn
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan Pollock
- Department of Health and Social Sciences, University of the West of England Bristol, Bristol, UK
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Triantafyllias K, Heller C, de Blasi M, Galle PR, Schwarting A. Diagnostic Value of Optical Spectral Transmission in Rheumatoid Arthritis: Associations with Clinical Characteristics and Comparison with Joint Ultrasonography. J Rheumatol Suppl 2020; 47:1314-1322. [PMID: 32238511 DOI: 10.3899/jrheum.190650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the value of optical spectral transmission (OST) in detecting joint inflammation in patients with rheumatoid arthritis (RA) and to evaluate whether OST correlates with certain patient characteristics. METHODS OST measurements were performed in the metacarpophalangeal, proximal intraphalangeal, and wrist joints of 168 patients with RA and 114 controls. OST difference between the 2 groups was statistically examined and subsequently controlled for the effect of possible confounding factors. Diagnostic OST performance was tested by receiver-operating characteristics. Moreover, associations of OST with clinical and serological activity markers (patient group), joint ultrasound (US; patient subgroup) and various anthropometric and epidemiologic parameters (patient and control group) were evaluated by Spearman correlation coefficient and a generalized linear statistical adjustment model. RESULTS OST was significantly higher in the RA group than in the control group, even after adjustment for confounding factors (1.89; 95% CI 0.709-3.070, padj = 0.002). Taking US as a reference, area under the curve for all 1251 joints simultaneously was 0.67 (95% CI 0.631-0.709). In the patient group, correlation and adjustment analyses showed associations of OST with various disease activity markers [28-joint count Disease Activity Score (rho 0.313), swollen joint counts (rho 0.361), C-reactive protein (rho 0.389); all, padj = 0.001], age (rho 0.276, p < 0.001), and osteoarthritis (p = 0.022). Moreover, OST associated with a power Doppler US score (rho 0.442; p = 0.001) and a greyscale US score (rho 0.591; p < 0.001). In both groups males had significantly higher OST values than females and OST associated moderately weakly with body mass index (rho patients 0.316, rho controls 0.24; all, p < 0.001). CONCLUSION Patients with RA showed higher OST values in comparison to controls. Moreover, OST associated with clinical, US, and laboratory disease activity markers.
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Affiliation(s)
- Konstantinos Triantafyllias
- From the ACURA Rheumatology Center Rhineland-Palatinate, Bad Kreuznach; Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; Internal Medicine I, Department of Gastroenterology, University Medical Center of Johannes Gutenberg University, Mainz, Germany. .,K. Triantafyllias, MD, ACURA Rheumatology Center Rhineland-Palatinate; C. Heller, Medical Student, Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; M. de Blasi, Medical Informatics Engineer, ACURA Rheumatology Center Rhineland-Palatinate; P.R. Galle, MD, Professor, Internal Medicine I, Department of Gastroenterology, University Medical Center of the Johannes Gutenberg University; .,A. Schwarting, MD, Professor, ACURA Rheumatology Center Rhineland-Palatinate, and Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center.
| | - Caroline Heller
- From the ACURA Rheumatology Center Rhineland-Palatinate, Bad Kreuznach; Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; Internal Medicine I, Department of Gastroenterology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,K. Triantafyllias, MD, ACURA Rheumatology Center Rhineland-Palatinate; C. Heller, Medical Student, Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; M. de Blasi, Medical Informatics Engineer, ACURA Rheumatology Center Rhineland-Palatinate; P.R. Galle, MD, Professor, Internal Medicine I, Department of Gastroenterology, University Medical Center of the Johannes Gutenberg University.,A. Schwarting, MD, Professor, ACURA Rheumatology Center Rhineland-Palatinate, and Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center
| | - Michele de Blasi
- From the ACURA Rheumatology Center Rhineland-Palatinate, Bad Kreuznach; Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; Internal Medicine I, Department of Gastroenterology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,K. Triantafyllias, MD, ACURA Rheumatology Center Rhineland-Palatinate; C. Heller, Medical Student, Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; M. de Blasi, Medical Informatics Engineer, ACURA Rheumatology Center Rhineland-Palatinate; P.R. Galle, MD, Professor, Internal Medicine I, Department of Gastroenterology, University Medical Center of the Johannes Gutenberg University.,A. Schwarting, MD, Professor, ACURA Rheumatology Center Rhineland-Palatinate, and Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center
| | - Peter Robert Galle
- From the ACURA Rheumatology Center Rhineland-Palatinate, Bad Kreuznach; Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; Internal Medicine I, Department of Gastroenterology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,K. Triantafyllias, MD, ACURA Rheumatology Center Rhineland-Palatinate; C. Heller, Medical Student, Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; M. de Blasi, Medical Informatics Engineer, ACURA Rheumatology Center Rhineland-Palatinate; P.R. Galle, MD, Professor, Internal Medicine I, Department of Gastroenterology, University Medical Center of the Johannes Gutenberg University.,A. Schwarting, MD, Professor, ACURA Rheumatology Center Rhineland-Palatinate, and Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center
| | - Andreas Schwarting
- From the ACURA Rheumatology Center Rhineland-Palatinate, Bad Kreuznach; Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; Internal Medicine I, Department of Gastroenterology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,K. Triantafyllias, MD, ACURA Rheumatology Center Rhineland-Palatinate; C. Heller, Medical Student, Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center; M. de Blasi, Medical Informatics Engineer, ACURA Rheumatology Center Rhineland-Palatinate; P.R. Galle, MD, Professor, Internal Medicine I, Department of Gastroenterology, University Medical Center of the Johannes Gutenberg University.,A. Schwarting, MD, Professor, ACURA Rheumatology Center Rhineland-Palatinate, and Internal Medicine I, Department of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center
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Carr ECJ, Ortiz MM, Patel JN, Barber CEH, Katz S, Robert J, Mosher D, Teare SR, Miller J, Homik J, Dinsmore K, Marshall DA. Models of Arthritis Care: A Systems-level Evaluation of Acceptability as a Dimension of Quality of Care. J Rheumatol 2020; 47:1431-1439. [PMID: 31732557 DOI: 10.3899/jrheum.190501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe a systems-level baseline evaluation of central intake (CI) and triage systems in arthritis care within Alberta, Canada. The specific objectives were to (1) describe a process for systems evaluation for the provision of arthritis care; (2) report the findings of the evaluation for different clinical sites that provide arthritis care; and (3) identify opportunities for improving appropriate and timely access based on the findings of the evaluation. METHODS The study used a convergent mixed methods design. Surveys and semistructured interviews were the main data collection methods. Participants were recruited through 2 rheumatology clinics and 1 hip and knee clinic providing CI and triage, and included patients, referring physicians, specialists, and clinic staff who experienced CI processes. RESULTS A total of 237 surveys were completed by patients (n = 169), referring physicians (n = 50), and specialists (n = 18). Interviews (n = 25) with care providers and patients provided insights to the survey data. Over 95% of referring physicians agreed that the current process of CI was satisfactory. Referring physicians and specialists reported issues with the referral process and perceived support in care for wait-listed patients. Patients reported positive experiences with access and navigation of arthritis care services but expressed concerns around communication and receiving minimal support for self-management of their arthritis before and after receiving specialist care. CONCLUSION This baseline evaluation of CI and triage for arthritis care indicates satisfaction with the service, but areas that require further consideration are referral completion, timely waiting lists, and further supporting patients to self-manage their arthritis.
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Affiliation(s)
- Eloise C J Carr
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada. .,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary.
| | - Mia M Ortiz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jatin N Patel
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Claire E H Barber
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Steven Katz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jill Robert
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Dianne Mosher
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Sylvia R Teare
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jean Miller
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Joanne Homik
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Kelly Dinsmore
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
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Carbone L, Vasan S, Elam R, Gupta S, Tolaymat O, Crandall C, Wactawski-Wende J, Johnson KC. The Association of Methotrexate, Sulfasalazine, and Hydroxychloroquine Use With Fracture in Postmenopausal Women With Rheumatoid Arthritis: Findings From the Women's Health Initiative. JBMR Plus 2020; 4:e10393. [PMID: 33103025 PMCID: PMC7574701 DOI: 10.1002/jbm4.10393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023] Open
Abstract
This study was conducted to evaluate the extent to which disease‐modifying antirheumatic medications (DMARDs) used as part of a triple therapy for the treatment of rheumatoid arthritis (RA) including methotrexate, sulfasalazine, and hydroxychloroquine are associated with fractures in postmenopausal women with RA. Incident fractures following use of methotrexate, sulfasalazine, and/or hydroxychloroquine in postmenopausal women with RA in the Women's Health Initiative were estimated by Cox proportional hazards using hazard ratios (HRs) and 95% CIs after consideration of potential confounders. There were 1201 women with RA enrolled in the Women's Health Initiative included in these analyses, of which 74% were white, 17% were black, and 9% were of other or unknown race/ethnicity. Of the women with RA, 421 (35%) had not used methotrexate, sulfasalazine, or hydroxychloroquine, whereas 519 (43%) women had used methotrexate, 83 (7%) sulfasalazine, and 363 (30%) hydroxychloroquine alone or in combination at some time during study follow‐up. Over a median length of 6.46 years of follow‐up, in multivariable adjusted models, no statistically significant association was found between methotrexate (HR, 1.1; 95% CI, 0.8–1.6), sulfasalazine (HR, 0.6; 95% CI, 0.2–1.5), or hydroxychloroquine (HR, 1.0; 95% CI, 0.7–1.5) use and incident fractures or between combination therapy with methotrexate and sulfasalazine or methotrexate and hydroxychloroquine use (HR, 0.9; 95% CI, 0.5–1.6) and incident fractures. In conclusion, postmenopausal women with RA receiving any component of triple therapy should not be expected to have any substantial reduction in fracture risk from use of these DMARDs. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Laura Carbone
- Department of Medicine, Division of Rheumatology, J. Harold Harrison MD, Distinguished University Chair in Rheumatology Medical College of Georgia at Augusta University Augusta GA USA.,Department of Rheumatology Charlie Norwood Veterans Affairs Medical Center Augusta GA USA
| | - Sowmya Vasan
- Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Rachel Elam
- Department of Rheumatology Charlie Norwood Veterans Affairs Medical Center Augusta GA USA.,Department of Medicine, Division of Rheumatology Medical College of Georgia at Augusta University Augusta GA USA
| | - Sandeepkumar Gupta
- Department of Medicine, Division of Rheumatology Medical College of Georgia at Augusta University Augusta GA USA
| | - Omar Tolaymat
- Department of Medicine, Division of Rheumatology Medical College of Georgia at Augusta University Augusta GA USA
| | - Carolyn Crandall
- Department of Medicine, Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at University of California, Los Angeles Los Angeles CA USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions University at Buffalo Buffalo NY USA
| | - Karen C Johnson
- Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN USA
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Li J, Yi X, Yao Z, Chakkalakal JV, Xing L, Boyce BF. TNF Receptor-Associated Factor 6 Mediates TNFα-Induced Skeletal Muscle Atrophy in Mice During Aging. J Bone Miner Res 2020; 35:1535-1548. [PMID: 32267572 PMCID: PMC7429284 DOI: 10.1002/jbmr.4021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022]
Abstract
During aging, muscle mass decreases, leading to sarcopenia, associated with low-level chronic inflammation (inflammaging), which induces sarcopenia by promoting proteolysis of muscle fibers and inhibiting their regeneration. Patients with a variety of pathologic conditions associated with sarcopenia, including rheumatoid arthritis (RA), have systemically elevated TNFα serum levels, and transgenic mice with TNFα overexpression (TNF-Tg mice, a model of RA) develop sarcopenia between adolescence and adulthood before they age. However, if and how TNFα contributes to the pathogenesis of sarcopenia during the normal aging process and in RA remains largely unknown. We report that TNFα levels are increased in skeletal muscles of aged WT mice, associated with muscle atrophy and decreased numbers of satellite cells and Type IIA myofibers, a phenotype that we also observed in adult TNF-Tg mice. Aged WT mice also have increased numbers of myeloid lineage cells in their skeletal muscles, including macrophages and granulocytes. These cells have increased TNFα expression, which impairs myogenic cell differentiation. Expression levels of TNF receptor-associated factor 6 (TRAF6), an E3 ubiquitin ligase, which mediates signaling by some TNF receptor (TNFR) family members, are elevated in skeletal muscles of both aged WT mice and adult TNF-Tg mice. TRAF6 binds to TNFR2 in C2C12 myoblasts and mediates TNFα-induced muscle atrophy through NF-κB-induced transcription of the muscle-specific E3 ligases, Atrogen1 and Murf1, which promote myosin heavy-chain degradation. Haplo-deficiency of TRAF6 prevents muscle atrophy and the decrease in numbers of satellite cells, Type IIA myofibers, and myogenic regeneration in TRAF6+/- ;TNF-Tg mice. Our findings suggest that pharmacologic inhibition of TRAF6 signaling in skeletal muscles during aging could treat/prevent age- and RA-related sarcopenia by preventing TNFα-induced proteolysis and inhibition of muscle fiber regeneration. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jinbo Li
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Xiangjiao Yi
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,School of Pharmacy, Minzu University of China, Beijing, China
| | - Zhenqiang Yao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Joe V Chakkalakal
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lianping Xing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brendan F Boyce
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Department of Orthopaedics and Rehabilitation Medicine, University of Rochester Medical Center, Rochester, NY, USA
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11
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Dakkak YJ, Matthijssen XME, van der Heijde D, Reijnierse M, van der Helm-van Mil AHM. Reliability of Magnetic Resonance Imaging (MRI) Scoring of the Metatarsophalangeal Joints of the Foot according to the Rheumatoid Arthritis MRI Score. J Rheumatol 2020; 47:1165-1173. [PMID: 31523041 DOI: 10.3899/jrheum.190258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) is validated for hand MRI. Its reliability applied to metatarsophalangeal (MTP 1-5) joints is unknown and was studied in early arthritis and clinically suspect arthralgia. METHODS Patients underwent 1.5 Tesla MRI of MTP, metacarpophalangeal (MCP 2-5), and wrist joints. Two paired readers scored bone marrow edema (BME), synovitis, tenosynovitis, and erosions. Interreader reliability was assessed of 441 consecutive early arthritis patients at baseline, 215 by 2 readers, and the remaining 226 by 2 different readers. Two readers scored baseline MRI of 82 consecutive patients with clinically suspect arthralgia, and 40 randomly selected patients by 9 readers. Intrareader reliability was determined on a random set of 15 early arthritis patients, scored twice by 2 readers. For change scores, 30 early arthritis patients with baseline and 1-year followup MRI were scored by 2 readers. Intraclass correlation coefficients (ICC), Bland-Altman (BA) plots, and smallest detectable change (SDC) were determined. MRI data of MTP joints were compared to wrist and MCP joints. RESULTS Interreader ICC and mean scores in early arthritis were BME ICC 0.91-0.92 (mean 1.5 ± SD 2.6), synovitis 0.90-0.92 (1.3 ± 1.7), tenosynovitis 0.80-0.85 (1.1 ± 1.8), and erosions 0.88-0.89 (0.7 ± 1.0). In patients with clinically suspect arthralgia, ICC were comparable. Intrareader ICC for inflammatory MRI features were 0.84-0.98, for erosions 0.71 (reader 1), and 0.92 (reader 2). Change score ICC were ≥ 0.90, except erosions (0.77). SDC were ≤ 1.0. BA plots showed no systematic bias. Reliability scores of MTP joints were similar to MCP and wrist joints. CONCLUSION Status and change MRI scores of BME, synovitis, tenosynovitis, and erosions of MTP joints can be assessed reliably by RAMRIS.
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Affiliation(s)
- Yousra J Dakkak
- From the Department of Rheumatology and the Department of Radiology, Leiden University Medical Centre, Leiden; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands. .,Y.J. Dakkak, MD, Department of Rheumatology, Leiden University Medical Centre; X.M. Matthijssen, MD, Department of Rheumatology, Leiden University Medical Centre; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Centre; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Centre; A.H. van der Helm-van Mil, MD, PhD, Department of Rheumatology, Leiden University Medical Centre, and Department of Rheumatology, Erasmus Medical Centre.
| | - Xanthe M E Matthijssen
- From the Department of Rheumatology and the Department of Radiology, Leiden University Medical Centre, Leiden; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands.,Y.J. Dakkak, MD, Department of Rheumatology, Leiden University Medical Centre; X.M. Matthijssen, MD, Department of Rheumatology, Leiden University Medical Centre; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Centre; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Centre; A.H. van der Helm-van Mil, MD, PhD, Department of Rheumatology, Leiden University Medical Centre, and Department of Rheumatology, Erasmus Medical Centre
| | - Désirée van der Heijde
- From the Department of Rheumatology and the Department of Radiology, Leiden University Medical Centre, Leiden; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands.,Y.J. Dakkak, MD, Department of Rheumatology, Leiden University Medical Centre; X.M. Matthijssen, MD, Department of Rheumatology, Leiden University Medical Centre; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Centre; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Centre; A.H. van der Helm-van Mil, MD, PhD, Department of Rheumatology, Leiden University Medical Centre, and Department of Rheumatology, Erasmus Medical Centre
| | - Monique Reijnierse
- From the Department of Rheumatology and the Department of Radiology, Leiden University Medical Centre, Leiden; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands.,Y.J. Dakkak, MD, Department of Rheumatology, Leiden University Medical Centre; X.M. Matthijssen, MD, Department of Rheumatology, Leiden University Medical Centre; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Centre; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Centre; A.H. van der Helm-van Mil, MD, PhD, Department of Rheumatology, Leiden University Medical Centre, and Department of Rheumatology, Erasmus Medical Centre
| | - Annette H M van der Helm-van Mil
- From the Department of Rheumatology and the Department of Radiology, Leiden University Medical Centre, Leiden; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands.,Y.J. Dakkak, MD, Department of Rheumatology, Leiden University Medical Centre; X.M. Matthijssen, MD, Department of Rheumatology, Leiden University Medical Centre; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Centre; M. Reijnierse, MD, PhD, Department of Radiology, Leiden University Medical Centre; A.H. van der Helm-van Mil, MD, PhD, Department of Rheumatology, Leiden University Medical Centre, and Department of Rheumatology, Erasmus Medical Centre
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12
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Muilu P, Rantalaiho V, Kautiainen H, Virta LJ, Puolakka K. Opioid Use among Patients with Early Inflammatory Arthritides Compared to the General Population. J Rheumatol 2020; 47:1285-1292. [PMID: 31615910 DOI: 10.3899/jrheum.190355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess to what extent the worldwide opioid epidemic affects Finnish patients with early inflammatory arthritis (IA). METHODS From the nationwide register maintained by the Social Insurance Institution of Finland, we collected all incident adult patients with newly onset seropositive and seronegative rheumatoid arthritis (RA+ and RA-) and undifferentiated arthritis (UA) between 2010 and 2014. For each case, 3 general population (GP) controls were matched according to age, sex, and place of residence. Drug purchases between 2009 and 2015 were evaluated 1 year before and after the index date (date of IA diagnosis), further dividing this time into 3-month periods. RESULTS A total of 12,115 patients (66% women) were identified. At least 1 opioid purchase was done by 23-27% of the patients 1 year before and 15-20% one year after the index date. Relative risk (RR) of opioid purchases compared to GP was highest during the last 3-month time period before the index date [RR 2.81 (95% CI 2.55-3.09), 3.06 (2.68-3.49), and 4.04 (3.51-4.65) for RA+, RA-, and UA, respectively] but decreased after the index date [RR 1.38 (1.23-1.58), 1.91 (1.63-2.24), and 2.51 (2.15-2.93)]. Up to 4% of the patients were longterm users both before and after the diagnosis. CONCLUSION During 2009-15 in Finland, opioid use peaked just before the diagnosis of IA but decreased rapidly after that, suggesting effective disease control, especially in seropositive RA. Further, opioids were used to treat arthritis pain of patients with incident RA and UA less often than previously reported from other countries.
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Affiliation(s)
- Paula Muilu
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland. .,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital.
| | - Vappu Rantalaiho
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
| | - Hannu Kautiainen
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
| | - Lauri Juhani Virta
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
| | - Kari Puolakka
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
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Harrold LR, Griffith J, Zueger P, Litman HJ, Gershenson B, Islam SS, Barr CJ, Guo D, Fay J, Greenberg JD. Longterm, Real-world Safety of Adalimumab in Rheumatoid Arthritis: Analysis of a Prospective US-based Registry. J Rheumatol 2020; 47:959-967. [PMID: 31371657 DOI: 10.3899/jrheum.190260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess longterm safety in a US cohort of patients with rheumatoid arthritis (RA) treated with adalimumab (ADA) in real-world clinical care settings. METHODS This observational study analyzed the longterm incidence of safety outcomes among patients with RA initiating ADA, using data from the Corrona RA registry. Patients were adults (≥ 18 yrs) who initiated ADA treatment between January 2008 and June 2017, and who had at least 1 followup visit. RESULTS In total, 2798 ADA initiators were available for analysis, with a mean age of 54.5 years, 77% female, and mean disease duration of 8.3 years. Nearly half (48%) were biologic-naive, and 9% were using prednisone ≥ 10 mg at ADA initiation. The incidence rates per 100 person-years for serious infections, congestive heart failure requiring hospitalization, malignancy (excluding nonmelanoma skin cancer), and all-cause mortality were 1.86, 0.15, 0.64, and 0.33, respectively. The incidence of serious infections was higher in the first year of therapy (3.44, 95% CI 2.45-4.84) than in subsequent years, while other measured adverse effects did not vary substantially by duration of exposure. The median time to ADA discontinuation was 11 months, while the median time to first serious infection among those experiencing a serious infection event was 12 months. CONCLUSION Analysis of longterm data from this prospective real-world registry demonstrated a safety profile consistent with previous studies in patients with RA. This analysis did not identify any new safety signals associated with ADA treatment and provides guidance for physicians prescribing ADA for extended periods.
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Affiliation(s)
- Leslie R Harrold
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA.
| | - Jenny Griffith
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Patrick Zueger
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Heather J Litman
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Bernice Gershenson
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Syed S Islam
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Christine J Barr
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Dianlin Guo
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Jonathan Fay
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Jeffrey D Greenberg
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
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Durán J, Massardo L, Llanos C, Iacobelli S, Burgos PI, Cisternas M, Iruretagoyena M, Armstrong M, Aguilera R, Radrigán F, Martinez ME, Passi-Solar A, Riedemann P, Crisóstomo N, Cifuentes C, Hagedorn L, Cisternas A, Vasquez N, Margozzini P. The Prevalence of Rheumatoid Arthritis in Chile: A Nationwide Study Performed as Part of the National Health Survey. J Rheumatol 2020; 47:951-958. [PMID: 31474598 DOI: 10.3899/jrheum.190396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Genetic and environmental backgrounds influence the development of rheumatoid arthritis (RA). In Latin America, epidemiologic data are scarce. We aimed to determine the prevalence of RA in Chile in a population-based study. METHODS The National Health Survey was a cross-sectional household survey with a stratified multistage probability sample of 6233 participants performed between August 2016 and March 2017. A screening instrument for RA was applied to a random sample of 3847 subjects > 30 years old. Positive screening was defined by at least 1 of the following: 2 swollen joints for at least 4 consecutive weeks (past/present), and/or a diagnosis of arthritis in the past. Individuals with positive screening had rheumatoid factor, anticitrullinated protein antibodies, and C-reactive protein measured, as well as clinical examination performed by a rheumatologist. Self-report of doctor-diagnosed RA was also performed. RESULTS The screening questionnaire was applied to 2998 subjects. A positive screening was found for 783 (22.1%). Among subjects with positive screening, 493 (66%) had a clinical evaluation performed by a rheumatologist. Using the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria, prevalence was 0.6% (95% CI 0.3-1.2). Prevalence was higher in women, and 3.3% of subjects self-reported having RA. CONCLUSION According to this national population-based study, RA prevalence in Chile is 0.6% (0.3-1.2), a value similar to what has been found in developed countries and slightly lower than some Latin American countries. Self-reporting leads to overestimating RA.
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Renner N, Kleyer A, Krönke G, Simon D, Söllner S, Rech J, Uder M, Janka R, Schett G, Welsch GH, Pachowsky ML. T2 Mapping as a New Method for Quantitative Assessment of Cartilage Damage in Rheumatoid Arthritis. J Rheumatol 2020; 47:820-825. [PMID: 31416926 DOI: 10.3899/jrheum.180728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with damage of the articular cartilage and the periarticular bone. While imaging of bone damage has substantially improved in recent years, direct imaging of the articular cartilage of the hand joints in patients with RA is still challenging. The study used T2 mapping of the finger joints to assess cartilage damage in RA. METHODS Magnetic resonance imaging (MRI) at 3 Tesla was done in 30 patients with RA, and T2 relaxation times visualizing alteration in the collagen network and hydration of articular cartilage were mapped in 6 cartilage regions of the metacarpophalangeal (MCP) joints 2 and 3. Values were related to autoantibody status [anticitrullinated protein antibodies (ACPA), rheumatoid factor (RF)], disease duration, and disease activity as well as sex and age of the patients. RESULTS T2 relaxation times could be reliably measured in the 6 regions of the MCP joints. Significantly higher relaxation times indicating more advanced cartilage alterations were observed in the metacarpal heads of ACPA-positive (p = 0.001-0.010) and RF-positive patients (p = 0.013-0.025) as well as those with longer disease duration (> 3 yrs; p = 0.028-0.043). Current disease activity, sex, and age did not influence T2 relaxation times. CONCLUSION These data show that cartilage damage can be localized and quantified in the hand joints of patients with RA by T2 mapping. Further, ACPA and RF positivity as well as disease duration appear to be the crucial factors influencing cartilage damage.
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Affiliation(s)
- Nina Renner
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Arnd Kleyer
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Gerhard Krönke
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - David Simon
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Stefan Söllner
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Jürgen Rech
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Michael Uder
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Rolf Janka
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Georg Schett
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Goetz H Welsch
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen
| | - Milena L Pachowsky
- From the Department of Trauma and Orthopaedic Surgery, the Department of Internal Medicine 3, and the Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); Universitätsklinikum Erlangen, Erlangen; UKE Athleticum, University Hospital of Hamburg-Eppendorf, Hamburg, Germany. .,N. Renner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; A. Kleyer, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G. Krönke, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; D. Simon, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; S. Söllner, MD, Department of Trauma and Orthopaedic Surgery, FAU, and Universitätsklinikum Erlangen; J. Rech, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; M. Uder, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; R. Janka, MD, Department of Radiology, FAU, and Universitätsklinikum Erlangen; G. Schett, MD, Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen; G.H. Welsch, MD, UKE Athleticum, University Hospital of Hamburg-Eppendorf; M.L. Pachowsky, MD, MHBA, Department of Trauma and Orthopaedic Surgery and Department of Internal Medicine 3, FAU, and Universitätsklinikum Erlangen.
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George MD, Baker JF, Ogdie A. Comparative Persistence of Methotrexate and Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. J Rheumatol 2020; 47:826-834. [PMID: 31474599 PMCID: PMC7050382 DOI: 10.3899/jrheum.190299] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Accepted: 08/22/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The role of methotrexate (MTX) for the treatment of spondyloarthritis (SpA) remains uncertain. Aims were to compare MTX and tumor necrosis factor inhibitor (TNFi) persistence in spondyloarthritis versus rheumatoid arthritis (RA) and to determine whether concomitant conventional synthetic disease-modifying antirheumatic drug (csDMARD) use is associated with improved TNFi persistence in SpA. METHODS This retrospective cohort study using Optum's deidentified Clinformatics Data Mart Database 2000-2014 identified patients with RA, psoriatic arthritis (PsA), and ankylosing spondylitis (AS) without prior biologic use who were initiating MTX or a TNFi. Cox proportional hazards models compared time to medication discontinuation over the next 2 years between patients with RA, PsA, or AS, adjusting for potential confounders. In similar analyses stratified by disease, Cox models were used to assess whether concomitant use of csDMARD was associated with TNFi persistence. RESULTS We identified 31,527 MTX initiators (26,708 RA, 2939 PsA, 1880 AS) and 34,651 TNFi initiators (24,134 RA, 6705 PsA, 3812 AS). MTX was discontinued sooner in patients with PsA [adjusted HR (aHR) 1.10, 95% CI 1.04-1.16] and AS (aHR 1.23, 1.16-1.31) versus RA, while TNFi were discontinued at similar rates in RA and AS and discontinued later in PsA (aHR 0.93, 0.89-0.97). Concomitant use of MTX (compared to no csDMARD) was associated with lower rates of TNFi discontinuation in RA (aHR 0.85, 0.80-0.89), PsA (aHR 0.81, 0.74-0.89), and AS (aHR 0.79, 0.67-0.93). CONCLUSION MTX discontinuation occurs sooner in patients with PsA and AS versus RA. Concomitant use of MTX with a TNFi, however, is associated with improved TNFi persistence in all 3 diseases.
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Affiliation(s)
- Michael D George
- From the University of Pennsylvania, Division of Rheumatology, and Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics; Philadelphia Veterans Affairs Medical Center, Division of Rheumatology, Philadelphia, Pennsylvania, USA.
- M.D. George, MD, MSCE, Instructor, University of Pennsylvania, Division of Rheumatology; J.F. Baker, MD, MSCE, Assistant Professor, Philadelphia VA Medical Center, Division of Rheumatology, and University of Pennsylvania; A. Ogdie, MD, MSCE, Assistant Professor, University of Pennsylvania, Division of Rheumatology, and Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics.
| | - Joshua F Baker
- From the University of Pennsylvania, Division of Rheumatology, and Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics; Philadelphia Veterans Affairs Medical Center, Division of Rheumatology, Philadelphia, Pennsylvania, USA
- M.D. George, MD, MSCE, Instructor, University of Pennsylvania, Division of Rheumatology; J.F. Baker, MD, MSCE, Assistant Professor, Philadelphia VA Medical Center, Division of Rheumatology, and University of Pennsylvania; A. Ogdie, MD, MSCE, Assistant Professor, University of Pennsylvania, Division of Rheumatology, and Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics
| | - Alexis Ogdie
- From the University of Pennsylvania, Division of Rheumatology, and Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics; Philadelphia Veterans Affairs Medical Center, Division of Rheumatology, Philadelphia, Pennsylvania, USA
- M.D. George, MD, MSCE, Instructor, University of Pennsylvania, Division of Rheumatology; J.F. Baker, MD, MSCE, Assistant Professor, Philadelphia VA Medical Center, Division of Rheumatology, and University of Pennsylvania; A. Ogdie, MD, MSCE, Assistant Professor, University of Pennsylvania, Division of Rheumatology, and Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics
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Youssef P, Marcal B, Button P, Truman M, Bird P, Griffiths H, Roberts L, Tymms K, Littlejohn G. Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset. J Rheumatol 2019; 47:1174-1181. [PMID: 31787605 DOI: 10.3899/jrheum.190535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To provide real-world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) when treating patients with rheumatoid arthritis (RA), and to assess (1) the primary failure rate for first-line treatment, and (2) the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi). METHODS This is a multicenter retrospective, noninterventional study of patients with RA enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARD between August 1, 2010, and June 30, 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation. RESULTS Data from 7740 patients were analyzed; 6914 patients received first-line b/tsDMARD. First-line treatment was stopped in 3383 (49%) patients; 1263 (37%) were classified as primary failures. The most common reason was "lack of efficacy" (947/2656, 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560) received second-line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first-line TNFi was for patients receiving rituximab (39 months, 95% CI 27-74). CONCLUSION A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARD with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of patients with RA.
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Affiliation(s)
- Peter Youssef
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia. .,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University.
| | - Bruno Marcal
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
| | - Peter Button
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
| | - Matt Truman
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
| | - Paul Bird
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
| | - Hedley Griffiths
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
| | - Lynden Roberts
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
| | - Kathleen Tymms
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
| | - Geoff Littlejohn
- From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.,P. Youssef, MD, Professor, Royal Prince Alfred Hospital, and University of Sydney; B. Marcal, BPharm, Roche Products Pty Ltd.; P. Button, MSc, OzBiostat Pty Ltd.; M. Truman, MSc, OzBiostat Pty Ltd.; P. Bird, MD, PhD, Grad Dip MRI, University of New South Wales; H. Griffiths, MD, Barwon Rheumatology Service; L. Roberts, MD, PhD, Associate Professor, Monash Rheumatology; K. Tymms, MD, Associate Professor, Canberra Rheumatology; G. Littlejohn, MD, Professor, Monash University
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Kuettel D, Primdahl J, Weber U, Terslev L, Østergaard M, Petersen R, Pedersen AK, Möller S, Hørslev-Petersen K. Pain and Self-reported Swollen Joints Are Main Drivers of Patient-reported Flares in Rheumatoid Arthritis: Results from a 12-month Observational Study. J Rheumatol 2019; 47:1305-1313. [PMID: 31787604 DOI: 10.3899/jrheum.190760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine prospectively self-reported flare characteristics and their longitudinal association with disease activity and patient-reported outcomes (PRO) in patients with rheumatoid arthritis (RA). METHODS Consecutive RA patients with 28-joint count Disease Activity Score based on C-reactive protein (DAS28-CRP) < 3.2 and no swollen joints were examined at baseline, Month 6, and Month 12. Assessments included joint counts, DAS28-CRP, visual analog scale-evaluator's global assessment (EGA), and PRO. Every third month, patients completed the Flare Assessment in Rheumatoid Arthritis and RA Flare Questionnaire, and disclosed self-management strategies. Flaring and non-flaring patients were compared and longitudinal associations between self-reported flare status (yes/no) and disease activity, PRO, and treatment escalation were explored. RESULTS Among 80 patients with RA [74% females, mean (SD) age 63 (10) yrs, disease duration 11 (7) yrs, and baseline DAS28-CRP 1.9 (0.6)], 64 (80%) reported flare at least once during 12 months. Fifty-five percent of flares lasted less than 1 week. Common self-management strategies were analgesics (50%) and restricted activities (38%). Patients who reported being in flare had consistently higher disease activity measures and PRO compared to patients without flare. In a partly adjusted model, all flare domains, patient-reported swollen and tender joint counts and disease activity measures were associated with flares. In fully adjusted analyses, present flare was independently associated with pain (OR 1.85, 95% CI 1.34-2.60), patient-reported swollen joints (OR 1.18, 95% CI 1.03-1.36), and higher EGA (OR 1.15, 95% CI 1.04-1.28). Treatment escalation was associated with present flare (p ≤ 0.001). CONCLUSION In RA, self-reported flares were frequent, mainly managed by analgesics, substantiated by higher disease activity measures, independently associated with pain and patient-reported swollen joints, and related to treatment escalation.
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Affiliation(s)
- Dorota Kuettel
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark.
| | - Jette Primdahl
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Ulrich Weber
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Lene Terslev
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Mikkel Østergaard
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Randi Petersen
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Andreas Kristian Pedersen
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Sören Möller
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
| | - Kim Hørslev-Petersen
- From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev-Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark
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19
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Poole JA, Thiele GM, Janike K, Nelson AJ, Duryee MJ, Rentfro K, England BR, Romberger DJ, Carrington JM, Wang D, Swanson BJ, Klassen LW, Mikuls TR. Combined Collagen-Induced Arthritis and Organic Dust-Induced Airway Inflammation to Model Inflammatory Lung Disease in Rheumatoid Arthritis. J Bone Miner Res 2019; 34:1733-1743. [PMID: 30995344 PMCID: PMC6744331 DOI: 10.1002/jbmr.3745] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/15/2019] [Accepted: 04/03/2019] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) is characterized by extra-articular involvement including lung disease, yet the mechanisms linking the two conditions are poorly understood. The collagen-induced arthritis (CIA) model was combined with the organic dust extract (ODE) airway inflammatory model to assess bone/joint-lung inflammatory outcomes. DBA/1J mice were intranasally treated with saline or ODE daily for 5 weeks. CIA was induced on days 1 and 21. Treatment groups included sham (saline injection/saline inhalation), CIA (CIA/saline), ODE (saline/ODE), and CIA + ODE (CIA/ODE). Arthritis inflammatory scores, bones, bronchoalveolar lavage fluid, lung tissues, and serum were assessed. In DBA/1J male mice, arthritis was increased in CIA + ODE > CIA > ODE versus sham. Micro-computed tomography (µCT) demonstrated that loss of BMD and volume and deterioration of bone microarchitecture was greatest in CIA + ODE. However, ODE-induced airway neutrophil influx and inflammatory cytokine/chemokine levels in lavage fluids were increased in ODE > CIA + ODE versus sham. Activated lung CD11c+ CD11b+ macrophages were increased in ODE > CIA + ODE > CIA pattern, whereas lung hyaluronan, fibronectin, and amphiregulin levels were greatest in CIA + ODE. Serum autoantibody and inflammatory marker concentrations varied among experimental groups. Compared with male mice, female mice showed less articular and pulmonary disease. The interaction of inhalation-induced airway inflammation and arthritis induction resulted in compartmentalized responses with the greatest degree of arthritis and bone loss in male mice with combined exposures. Data also support suppression of the lung inflammatory response, but increases in extracellular matrix protein deposition/interstitial disease in the setting of arthritis. This coexposure model could be exploited to better understand and treat RA-lung disease. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jill A. Poole
- Department of Internal Medicine, Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center (UNMC)
| | - Geoffrey M. Thiele
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE
- Department of Internal Medicine, Rheumatology Division, UNMC
| | - Katherine Janike
- Department of Internal Medicine, Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center (UNMC)
| | - Amy J. Nelson
- Department of Internal Medicine, Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center (UNMC)
| | - Michael J. Duryee
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE
- Department of Internal Medicine, Rheumatology Division, UNMC
| | - Kathryn Rentfro
- Department of Internal Medicine, Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center (UNMC)
| | - Bryant R. England
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE
- Department of Internal Medicine, Rheumatology Division, UNMC
| | - Debra J. Romberger
- Department of Internal Medicine, Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center (UNMC)
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE
| | - Joseph M. Carrington
- Department of Internal Medicine, Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center (UNMC)
| | | | | | - Lynell W. Klassen
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE
- Department of Internal Medicine, Rheumatology Division, UNMC
| | - Ted R. Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE
- Department of Internal Medicine, Rheumatology Division, UNMC
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20
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Skougaard M, Bliddal H, Christensen R, Ellegaard K, Nielsen SM, Zavada J, Oreska S, Krogh NS, Holm CC, Hetland ML, Vencovsky J, Røgind H, Taylor PC, Gudbergsen H. Patients with Rheumatoid Arthritis Acquire Sustainable Skills for Home Monitoring: A Prospective Dual-country Cohort Study (ELECTOR Clinical Trial I). J Rheumatol 2019; 47:658-667. [PMID: 31416921 DOI: 10.3899/jrheum.181362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In an eHealth setting, to investigate intra- and interrater reliability and agreement of joint assessments and Disease Activity Score using C-reactive protein (DAS28-CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training. METHODS Patients with DAS28-CRP ≤ 5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intrarater reliability and agreement of patient-performed joint counts were assessed through completion of 5 joint assessments over a 2-month period. All patients received training on joint assessment at baseline; only half of the patients received repeated training. A subset of patients was included in an appraisal of interrater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCP), and ultrasonography. Cohen's κ coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28-CRP. Agreement was assessed using Bland-Altman plots. RESULTS Intrarater reliability was excellent with ICC of 0.87 (95% CI 0.83-0.90) and minimal detectable change of 1.13. ICC for interrater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28-CRP slightly higher than HCP. In patients receiving repeated training, a mean difference in DAS28-CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCP was similar between groups receiving single or repeated training. CONCLUSION Patient-performed assessments of joints and DAS28-CRP in an eHealth home-monitoring solution were reliable and comparable with HCP. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training. [clinicaltrials.gov (NCT02317939)].
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Affiliation(s)
- Marie Skougaard
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henning Bliddal
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Robin Christensen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Karen Ellegaard
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Sabrina M Nielsen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Jakub Zavada
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Sabina Oreska
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Niels S Krogh
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Christian C Holm
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Merete L Hetland
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Jiri Vencovsky
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henrik Røgind
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Peter C Taylor
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henrik Gudbergsen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. .,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform. .,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg.
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Keystone EC, Rampakakis E, Movahedi M, Cesta A, Stutz M, Sampalis JS, Nantel F, Maslova K, Bombardier C. Toward Defining Primary and Secondary Nonresponse in Rheumatoid Arthritis Patients Treated with Anti-TNF: Results from the BioTRAC and OBRI Registries. J Rheumatol 2019; 47:510-517. [PMID: 31263067 DOI: 10.3899/jrheum.190102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although most patients with rheumatoid arthritis (RA) respond to anti-tumor necrosis factor (anti-TNF) treatment, some present with initial nonresponse (1ry nonresponse) or lose initial responsiveness (2ry nonresponse). We compared the rate of real-world "nonresponse" to first anti-TNF as reported by treating physicians to the nonresponse rate per accepted definitions and recommended treat-to-target strategies. METHODS Patients were included from the Biologic Treatment Registry Across Canada (BioTRAC) and Ontario Best Practices Research Initiative (OBRI) registries who were taking their first anti-TNF, with ≥ 1 followup visit. Posthoc reclassification of physician-reported nonresponse was based on prior achievement of 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR) low disease activity (LDA), Clinical Disease Activity Index (CDAI) LDA, or good/moderate European League Against Rheumatism (EULAR) response, and actual time of physician-reported nonresponse. RESULTS Among 736 BioTRAC and 640 OBRI patients, 13.7% and 18%, respectively, discontinued their anti-TNF because of physician-reported nonresponse. Based on reclassification using disease activity, 65.6% (BioTRAC) and 87.2% (OBRI) of 1ry nonresponders did not achieve DAS28-ESR LDA, 65.6%/90.7% CDAI LDA, and 46.9%/61.5% good/moderate EULAR response. Among 2ry nonresponders, 50.7%/47.8% did not achieve DAS28-ESR LDA, 37.7%/52.9% CDAI LDA, and 15.9%/19.6% good/moderate EULAR response before treatment discontinuation. Regarding actual time of nonresponse, 18.8% of BioTRAC and 60.8% of OBRI 1ry nonresponders discontinued at ≤ 6 months. In both registries, a high proportion of 2ry nonresponders discontinued their anti-TNF after 12 months (87.0% BioTRAC, 60.9% OBRI). CONCLUSION Physician-reported 1ry nonresponse was more correlated with non-achievement of DAS28-ESR LDA or CDAI LDA, whereas 2ry nonresponse with actual time of discontinuation. Further work is needed to confirm the importance of response and type of response to the initial anti-TNF in identifying patients most likely to benefit from a second biologic agent treatment.
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Affiliation(s)
- Edward C Keystone
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada. .,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology.
| | - Emmanouil Rampakakis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Mohammad Movahedi
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Angela Cesta
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Melissa Stutz
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - John S Sampalis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Francois Nantel
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Karina Maslova
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Claire Bombardier
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
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Peña M, Quirós-Donate J, Pérez Fernández E, Crespí-Villarías N, Dieguez Costa E, García-Vadillo A, Espinosa M, Macía-Villa C, Morell-Hita JL, Martinez-Prada C, Villaverde V, Morado Quiroga I, Guzón-Illescas O, Barbadillo C, Fernandez Prada M, Godoy H, Herranz Varela A, Galindo Izquierdo M, Mazzucchelli R. Orthopedic Surgery in Rheumatoid Arthritis: Results from the Spanish National Registry of Hospitalized Patients over 17 Years. J Rheumatol 2019; 47:341-348. [PMID: 31203231 DOI: 10.3899/jrheum.190182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the trend of orthopedic surgery (OS) rates on patients with rheumatoid arthritis (RA). METHODS Retrospective observational study based on information provided by the Spanish National System of Hospital Data Surveillance. All hospitalizations of patients with RA for orthopedic surgery [total hip arthroplasty (THA), total knee arthroplasty (TKA), arthrodesis, and upper limb arthroplasty (ULA)] during 1999-2015 were analyzed. The age-adjusted rate was calculated. Generalized linear models were used for trend analysis. RESULTS There were 21,088 OS in patients over 20 years of age (77.9% women). OS rate adjusted by age was 754.63/100,000 RA patients/year (women 707.4, men 861.1). Neither an increasing nor a decreasing trend was noted for the total OS. However, trend and age interacted, so in the age ranges 20-40 years and 40-60 years, an annual reduction of 2.69% and 2.97%, respectively, was noted. In the age ranges over 80 years and 60-80 years, we noted an annual increase of 5.40% and 1.09%, respectively. The average age at time of OS increased 5.5 years during the period analyzed. For specific surgeries, a global annual reduction was noted in rates for arthrodesis. In THA, there was an annual reduction in patients under 80 years. In TKA and ULA, there was an annual reduction in patients under 60 years. CONCLUSION Although the overall OS rate has not changed, there is a decrease in the rate of arthrodesis at all ages, THA in patients under 80 years of age, as well as TKA and ULA in patients under 60 years of age.
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Affiliation(s)
- Marina Peña
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Javier Quirós-Donate
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Elia Pérez Fernández
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Natalia Crespí-Villarías
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Elisa Dieguez Costa
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Alberto García-Vadillo
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - María Espinosa
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Cristina Macía-Villa
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Jose Luis Morell-Hita
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Cristina Martinez-Prada
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Virginia Villaverde
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Inmaculada Morado Quiroga
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Olalla Guzón-Illescas
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Carmen Barbadillo
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Manuel Fernandez Prada
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Hilda Godoy
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Angela Herranz Varela
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - María Galindo Izquierdo
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón
| | - Ramón Mazzucchelli
- From the Department of Rehabilitation, and Department of Rheumatology, Hospital Universitario Fundación Alcorcón, and Department of Clinical Research, Hospital Universitario Fundación Alcorcón; Centro de Salud La Rivota (Alcorcón); Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; Department of Rheumatology, Hospital Universitario de la Princesa; Department of Rheumatology, Hospital Universitario Puerta de Hierro; Department of Rheumatology, Hospital Universitario Severo Ochoa; Department of Rheumatology, Hospital Universitario Ramón y Cajal; Department of Rheumatology, Hospital Universitario Clínico San Carlos; Department of Rheumatology, Hospital Universitario de Móstoles; Department of Rheumatology, Hospital Universitario del Henares; Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid; Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain. .,M. Peña, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; J. Quirós-Donate, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón; E. Pérez Fernández, MD, Department of Clinical Research, Hospital Universitario Fundación Alcorcón; N. Crespí-Villarías, MD, Centro de Salud La Rivota (Alcorcón); E. Dieguez Costa, MD, Department of Diagnostic Imaging, Hospital Vithas Nuestra Señora de América; A. García-Vadillo, MD, PhD, Department of Rheumatology, Hospital Universitario de la Princesa; M. Espinosa, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; C. Macía-Villa, MD, Department of Rheumatology, Hospital Universitario Severo Ochoa; J.L. Morell-Hita, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal; C. Martinez-Prada, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; V. Villaverde, MD, Department of Rheumatology, Hospital Universitario de Móstoles; I. Morado Quiroga, MD, Department of Rheumatology, Hospital Universitario Clínico San Carlos; O. Guzón-Illescas, MD, Department of Rehabilitation, Hospital Universitario Fundación Alcorcón; C. Barbadillo, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; M. Fernandez Prada, MD, Department of Rheumatology, Hospital Universitario de Guadalajara; H. Godoy, MD, Department of Rheumatology, Hospital Universitario Puerta de Hierro; A. Herranz Varela, MD, Department of Rheumatology, Hospital Universitario del Henares; M. Galindo Izquierdo, MD, PhD, Department of Rheumatology, Hospital Universitario 12 de Octubre; R. Mazzucchelli, MD, PhD, Department of Rheumatology, Hospital Universitario Fundación Alcorcón.
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Mahmoud TG, Huang J, Frits M, Iannaccone C, Bykerk V, Bingham CO, Weinblatt M, Shadick NA. Correlates of Successful Rheumatoid Arthritis Flare Management: Clinician-driven Treatment, Home-based Strategies, and Medication Change. J Rheumatol 2019; 47:333-340. [PMID: 31203222 DOI: 10.3899/jrheum.181160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Describe strategies used to manage rheumatoid arthritis (RA) flares that contribute to a successful postflare outcome. METHODS Data were collected from the BRASS registry, including clinical and patient-reported outcomes, and a survey with a Likert scale assessing postflare symptoms (better, unchanged, or worse). A logistic regression analysis adjusting for age, sex, flare number in the past 6 months, flare pain severity, home management, clinical consultation, and medication change was performed to evaluate factors influencing flare outcome. RESULTS Of 503 participants, 185 reported at least 1 flare that had resolved in the past 6 months, with median (interquartile range) 28-joint count Disease Activity Score based on C-reactive protein 3 score 2.1 (1.7-2.8). Compared with RA symptoms before the flare, 22 (12%) patients felt worse, 125 (68%) were unchanged, and 38 (20%) felt better. To manage flares, 72% of patients used home-based remedies, 23% sought clinical consultation, and 56% made medication change. Of 103 patients who changed medication, 70% did so without seeking clinical advice. Making a medication change (OR 3.48, 95% CI 1.68-7.21) and having lower flare pain (OR 0.83, 95% CI 0.71-0.97) were associated with better flare outcome. CONCLUSION Flares occur frequently even in patients with low disease activity. Independent of home-based or clinically guided care, making a medication change and having less severe pain during a flare were associated with better flare outcomes. Of interest, the decision to change medications was frequently made without clinical advice. Future studies might address how best to intervene when patients experience flares and whether patient-initiated medication changes have adverse outcomes.
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Affiliation(s)
- Taysir G Mahmoud
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. .,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School.
| | - Jie Huang
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
| | - Michelle Frits
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
| | - Christine Iannaccone
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
| | - Vivian Bykerk
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
| | - Clifton O Bingham
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
| | - Michael Weinblatt
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
| | - Nancy A Shadick
- From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
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Peterfy C, Kremer J, Rigby W, Singer N, Birchwood C, Gill D, Reiss W, Pei J, Michalska M. Magnetic Resonance Imaging (MRI) Results Following Discontinuation of Methotrexate in Rheumatoid Arthritis Treated with Subcutaneous Tocilizumab: The COMP-ACT MRI Substudy. J Rheumatol 2019; 47:325-332. [PMID: 31154414 DOI: 10.3899/jrheum.180953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess differences in joint damage and inflammation using magnetic resonance imaging (MRI) between patients with rheumatoid arthritis (RA) who achieved low disease activity with tocilizumab (TCZ) + methotrexate (MTX) and subsequently continued or discontinued MTX. METHODS In the COMP-ACT trial, US patients with RA received subcutaneous TCZ 162 mg + MTX. Those who achieved 28-joint count Disease Activity Score calculated with erythrocyte sedimentation rate (DAS28-ESR) ≤ 3.2 at Week 24 were randomized 1:1 (double-blind) to discontinue MTX (TCZ monotherapy; mono) or continue TCZ + MTX until Week 52. In a subset of patients, 1.5-Tesla MRI was used to obtain images of bilateral hands and wrists at weeks 24 and 40. Outcomes included changes in MRI-assessed synovitis, osteitis, erosion, and cartilage loss from Week 24 to Week 40, and in the proportion of patients with progression of each score. RESULTS Of 296 patients who achieved DAS28-ESR ≤ 3.2 at Week 24, 79 were enrolled in the pilot MRI substudy and randomized to TCZ mono (n = 38) or TCZ + MTX (n = 41). Treatment with either TCZ mono or TCZ + MTX suppressed erosion progression, synovitis, osteitis, and cartilage loss. The proportion of patients with no progression in each outcome measure was similar between groups (range, TCZ mono: 84.8-97.0%; TCZ + MTX: 92.3-100%). CONCLUSION In a subset of patients who achieved low disease activity with TCZ + MTX, MRI changes were minimal in intraarticular inflammation and damage measures in patients who discontinued MTX versus those who continued TCZ + MTX.
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Affiliation(s)
- Charles Peterfy
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA. .,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc.
| | - Joel Kremer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Rigby
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Nora Singer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Christine Birchwood
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Darcy Gill
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Reiss
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Jinglan Pei
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Margaret Michalska
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
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Emery P, Vlahos B, Szczypa P, Thakur M, Jones HE, Woolcott J, Santos Estrella PV, Rolland C, Gibofsky A, Citera G, Sockalingam S, Marshall L. Longterm Drug Survival of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis. J Rheumatol 2019; 47:493-501. [PMID: 31154413 DOI: 10.3899/jrheum.181398] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate longterm drug survival (proportion of patients still receiving treatment) and discontinuation of etanercept (ETN), infliximab (IFX), adalimumab (ADA), certolizumab pegol (CZP), and golimumab (GOL) using observational data from patients with rheumatoid arthritis (RA). METHODS Following a systematic literature review, drug survival at 12 and 12-24 months of followup was estimated by summing proportions of patients continuing treatment and dividing by number of studies. Drug survival at ≥ 36 months of followup was estimated through Metaprop. RESULTS There were 170 publications included. In the first-line setting, drug survival at 12 months with ETN, IFX, or ADA was 71%, 69%, and 70%, respectively, while at 12-24 months the corresponding rates were 63%, 57%, and 59%. In the second-line setting, drug survival at 12 months with ETN, IFX, or ADA was 61%, 69%, and 55%, respectively, while at 12-24 months the corresponding rates were 53%, 39%, and 43%. Drug survival at ≥ 36 months with ETN, IFX, or ADA in the first-line setting was 59% (95% CI 46-72%), 49% (95% CI 43-54%), and 51% (95% CI 41-60%), respectively, while in the second-line setting the corresponding rates were 56% (95% CI 52-61%), 48% (95% CI 40-55%), and 41% (95% CI 36-47%). Discontinuation of ETN, IFX, and ADA at 36 months of followup was 38-48%, 42-62%, and 38-59%, respectively. Data on CZP and GOL were scarce. CONCLUSION After > 12 months of followup, more patients with RA receiving ETN remain on treatment compared with other tumor necrosis factor inhibitors.
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Affiliation(s)
- Paul Emery
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK. .,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc.
| | - Bonnie Vlahos
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Piotr Szczypa
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Mazhar Thakur
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Heather E Jones
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - John Woolcott
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Paul V Santos Estrella
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Catherine Rolland
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Allan Gibofsky
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Gustavo Citera
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Sargunan Sockalingam
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
| | - Lisa Marshall
- From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds National Institute for Health Research (NIHR) Biomedical Research Centre, The Leeds Teaching Hospitals Trust, Leeds, UK.,P. Emery, FMedSci, Leeds Institute of Rheumatic and Musculoskeletal Medicine, and Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospitals Trust; B. Vlahos, MBA, Pfizer Inc.; P. Szczypa, MD, Pfizer Ltd.; M. Thakur, MD, Pfizer Ltd.; H.E. Jones, RN, Pfizer Inc.; J. Woolcott, PhD, Pfizer Inc.; P.V. Santos Estrella, MD, Pfizer Inc.; C. Rolland, PhD, Envision Pharma Group; A. Gibofsky, MD, Weill Medical College; G. Citera, MD, Instituto de Rehabilitación Psicofísica de Buenos Aires; S. Sockalingam, MMed, University Malaya Medical Centre; L. Marshall, PhD, Pfizer Inc
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Arad U, Elkayam O. Association of Serum Tocilizumab Trough Concentrations with Clinical Disease Activity Index Scores in Adult Patients with Rheumatoid Arthritis. J Rheumatol 2019; 46:1577-1581. [PMID: 31154416 DOI: 10.3899/jrheum.181431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine whether serum trough concentrations of tocilizumab (TCZ) administered as a fixed-dose subcutaneous (SC) injection for the treatment of rheumatoid arthritis (RA) are associated with disease activity responses. METHODS We analyzed datasets from the Israeli branch of the multinational TOZURA study, which evaluated a weekly subcutaneous TCZ treatment regimen in a real-life clinical setting. Generalized estimating equations (GEE) were used to evaluate associations between the TCZ levels and the study outcomes. Linear models and GEE were used to evaluate associations between patient characteristics and TCZ levels. RESULTS A significant association between the TCZ concentrations and the change in the Clinical Disease Activity Index (CDAI) score was observed. In a multivariate binary GEE model, every increase of 10 µg/ml in the concentration of TCZ was associated with being in a state of CDAI remission or low disease activity (OR 1.41) versus a moderate/high disease activity state. An OR of 1.52 was associated with being in a state of Health Assessment Questionnaire-Disability Index remission. In univariate linear models, there was an inverse association between body mass index (BMI) and improvement in the CDAI score, and the BMI score was associated with lower TCZ concentrations. Patients who weighed > 100 kg had lower TCZ concentrations. CONCLUSION In the first 24 weeks of treatment with SC TCZ injections, TCZ concentrations were associated with clinical improvement, while body weight and BMI were inversely associated with TCZ concentrations. Personalizing the dose of SC TCZ to body weight may improve outcomes of clinical disease activity in patients with RA.
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Affiliation(s)
- Uri Arad
- From the Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel. .,U. Arad, MD, PhD, Consultant Rheumatologist, Lecturer, Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; O. Elkayam, MD, Head of Department of Rheumatology, Associate Professor, Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University.
| | - Ori Elkayam
- From the Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,U. Arad, MD, PhD, Consultant Rheumatologist, Lecturer, Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; O. Elkayam, MD, Head of Department of Rheumatology, Associate Professor, Department of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University
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Ormseth MJ, Solus JF, Sheng Q, Ye F, Wu Q, Guo Y, Oeser AM, Allen RM, Vickers KC, Stein CM. Development and Validation of a MicroRNA Panel to Differentiate Between Patients with Rheumatoid Arthritis or Systemic Lupus Erythematosus and Controls. J Rheumatol 2019; 47:188-196. [PMID: 31092710 DOI: 10.3899/jrheum.181029] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE MicroRNA (miRNA) are short noncoding RNA that regulate genes and are both biomarkers and mediators of disease. We used small RNA (sRNA) sequencing and machine learning methodology to develop an miRNA panel to reliably differentiate between rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) and control subjects. METHODS Plasma samples from 167 RA and 91 control subjects who frequency-matched for age, race, and sex were used for sRNA sequencing. TIGER was used to analyze miRNA. DESeq2 and random forest analyses were used to identify a prioritized list of miRNA differentially expressed in patients with RA. Prioritized miRNA were validated by quantitative PCR, and lasso and logistic regression were used to select the final panel of 6 miRNA that best differentiated RA from controls. The panel was validated in a separate cohort of 12 SLE, 32 RA, and 32 control subjects. Panel efficacy was assessed by area under the receiver operative characteristic curve (AUC) analyses. RESULTS The final panel included miR-22-3p, miR-24-3p, miR-96-5p, miR-134-5p, miR-140-3p, and miR-627-5p. The panel differentiated RA from control subjects in discovery (AUC = 0.81) and validation cohorts (AUC = 0.71), seronegative RA (AUC = 0.84), RA remission (AUC = 0.85), and patients with SLE (AUC = 0.80) versus controls. Pathway analysis showed upstream regulators and targets of panel miRNA are associated with pathways implicated in RA pathogenesis. CONCLUSION An miRNA panel identified by a bioinformatic approach differentiated between RA or SLE patients and control subjects. The panel may represent an autoimmunity signature, perhaps related to inflammatory arthritis, which is not dependent on active disease or seropositivity.
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Affiliation(s)
- Michelle J Ormseth
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA. .,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center.
| | - Joseph F Solus
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - Quanhu Sheng
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - Fei Ye
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - Qiong Wu
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - Yan Guo
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - Annette M Oeser
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - Ryan M Allen
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - Kasey C Vickers
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
| | - C Michael Stein
- From the Tennessee Valley Healthcare System, US Department of Veterans Affairs; Department of Medicine, Vanderbilt University Medical Center; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Bioinformatics, University of New Mexico, Albuquerque, New Mexico, USA.,M.J. Ormseth, MD, Tennessee Valley Healthcare System, US Department of Veterans Affairs, and Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; Q. Sheng, PhD, Department of Biostatistics, Vanderbilt University Medical Center; F. Ye, PhD, Department of Biostatistics, Vanderbilt University Medical Center; Q. Wu, PhD, Department of Medicine, Vanderbilt University Medical Center; Y. Guo, PhD, Department of Bioinformatics, University of New Mexico; A.M. Oeser, BA, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; R.M. Allen, PhD, Department of Medicine, Vanderbilt University Medical Center; K.C. Vickers, PhD, Department of Medicine, Vanderbilt University Medical Center; C.M. Stein, MBChB, Department of Medicine, Vanderbilt University Medical Center
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Agca R, Hopman LHGA, Laan KJC, van Halm VP, Peters MJL, Smulders YM, Dekker JM, Nijpels G, Stehouwer CDA, Voskuyl AE, Boers M, Lems WF, Nurmohamed MT. Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study. J Rheumatol 2019; 47:316-324. [PMID: 31092721 DOI: 10.3899/jrheum.180726] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce. METHODS The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 3, 10, and 15 years after the start of the study and are compared to a reference cohort (n = 2540), including a large number of patients with type 2 diabetes (DM). RESULTS Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted HR for CV events were increased for RA (HR 2.07, 95% CI 1.57-2.72, p < 0.01) and DM (HR 1.51, 95% CI 1.02-2.22, p = 0.04) compared to the nondiabetic participants. HR was still increased in RA (HR 1.82, 95% CI 1.32-2.50, p < 0.01) after additional adjustment for CV risk factors. Patients with both RA and DM or insulin resistance had the highest HR for developing CVD (2.21, 95% CI 1.01-4.80, p = 0.046 and 2.67, 95% CI 1.30-5.46, p < 0.01, respectively). CONCLUSION The incidence rate of CV events in established RA was more than double that of the general population. Patients with RA have an even higher risk of CVD than patients with DM. This risk remained after adjustment for traditional CV risk factors, suggesting that systemic inflammation is an independent contributor to CV risk.
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Affiliation(s)
- Rabia Agca
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands. .,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam.
| | - Luuk H G A Hopman
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Koen J C Laan
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Vokko P van Halm
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Mike J L Peters
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Yvo M Smulders
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Jacqueline M Dekker
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Giel Nijpels
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Coen D A Stehouwer
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Alexandre E Voskuyl
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Maarten Boers
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Willem F Lems
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Michael T Nurmohamed
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
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Keeling SO, Bowker SL, Savu A, Kaul P. A Population-level Analysis of the Differing Effects of Rheumatoid Arthritis and Spondyloarthritis on Peripartum Outcomes. J Rheumatol 2019; 47:197-203. [PMID: 31043549 DOI: 10.3899/jrheum.181320] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The effects of rheumatoid arthritis (RA) and spondyloarthritis (SpA) on maternal and neonatal outcomes at a population level have not previously been well compared. METHODS A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. We identified 3 groups: (1) no inflammatory arthritis (no IA, n = 308,989), (2) RA (n = 631), and (3) SpA (n = 2461). We compared maternal and neonatal outcomes, comorbid conditions, and medication use among the 3 groups. Multivariable logistic regression models evaluated the independent association between RA and SpA, relative to no IA, and the outcomes of small for gestation age (SGA) and hypertensive disorders during pregnancy. RESULTS Pregnant women with RA were significantly more likely to have preterm delivery (13.5%), cesarean delivery (33.9%), hypertensive disorders in pregnancy (10.5%), and SGA babies (15.6%), compared to pregnant women with either SpA or no IA. Nonsteroidal antiinflammatory drugs and corticosteroid use were significantly higher in pregnant women with RA compared to the other groups. Women with RA were significantly more likely to have an SGA baby (OR 1.51, 95% CI 1.21-1.88; p < 0.01), and hypertensive disorder in pregnancy (OR 1.51, 95% CI 1.16-1.97; p < 0.01), compared to women with no IA, while no difference was found between women with SpA and those with no IA. CONCLUSION Women with RA have a higher risk of worse maternal and neonatal outcomes, whereas the risk of these events is similar between women with and without SpA.
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Affiliation(s)
- Stephanie O Keeling
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. .,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta.
| | - Samantha L Bowker
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Anamaria Savu
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Padma Kaul
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
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Abstract
OBJECTIVE Understanding the placebo response is critical to interpreting treatment efficacy, particularly for agents with a ceiling to their therapeutic effect, where an increasing placebo response makes it harder to detect potential benefit. The objective of this study is to assess the change in placebo responses over time in rheumatoid arthritis (RA) randomized placebo-controlled trials (RCT) for drug licensing authorization. METHODS The Cochrane Controlled Trials Register database was searched to identify RCT of biological or targeted synthetic disease-modifying antirheumatic drugs (DMARD) in RA. Studies were excluded if patients were conventional synthetic DMARD (csDMARD)-naive, not receiving background csDMARD therapy, or were biologic experienced. Metaregression model was used to evaluate changes in American College of Rheumatology (ACR) 20, ACR50, and ACR70 treatment response over time. RESULTS There were 32 trials in total: anti-tumor necrosis factor therapy (n = 15), tocilizumab (n = 4), abatacept (n = 2), rituximab (n = 2), and Janus kinase inhibitors (n = 9). From 1999 to 2018, there was no significant trend in the age or sex of patients in the placebo arm. Disease duration, swollen joint count, and 28-joint count Disease Activity Score using erythrocyte sedimentation rate at baseline all significantly declined over time. There was a statistically significant increase in placebo ACR50 and ACR70 responses (ACR50 β = 0.41, 95% CI 0.09-0.74, p = 0.01; ACR70 β = 0.18, 95% CI 0.04-0.31, p = 0.01) that remained significant after controlling for potential confounders. CONCLUSION There has been a rise in the placebo response in RA clinical trials over the last 2 decades. Shifting RA phenotype, changes in trial design, and expectation bias are possible explanations for this phenomenon. This observation has important implications when evaluating newer novel agents against established therapies.
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Affiliation(s)
- Katie Bechman
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK. .,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London.
| | - Mark Yates
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
| | - Sam Norton
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
| | - Andrew P Cope
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
| | - James B Galloway
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
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Berens HM, Polinski KJ, Mikuls TR, Khatter S, August J, Visser A, Mahler M, Weisman MH, O'Dell JR, Keating RM, Buckner JH, Gregersen PK, Norris JM, Holers VM, Deane KD, Demoruelle MK. Anticyclic Citrullinated Peptide Antibodies 3.1 and Anti-CCP-IgA Are Associated with Increasing Age in Individuals Without Rheumatoid Arthritis. J Rheumatol 2019; 46:1556-1559. [PMID: 30988128 DOI: 10.3899/jrheum.180897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We investigated the association of age and anticyclic citrullinated peptide antibodies (anti-CCP) in subjects without rheumatoid arthritis (RA). METHODS Serum was tested for anti-CCP3.1 (IgG/IgA) in 678 first-degree relatives (FDR) of patients with RA and 330 patients with osteoarthritis (OA). Individual isotypes (anti-CCP-IgA and anti-CCP-IgG) were also tested in all FDR. RESULTS In FDR, increasing age was significantly associated with positivity for anti-CCP3.1 (per year, OR 1.03) and anti-CCP-IgA (per year, OR 1.05) but not anti-CCP-IgG. In FDR and OA subjects, anti-CCP3.1 prevalence was significantly increased after age 50 years. CONCLUSION Increasing age in individuals without RA should be considered in the interpretation of anti-CCP3.1 positivity.
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Affiliation(s)
- Heather M Berens
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Kristen J Polinski
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Ted R Mikuls
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Sonia Khatter
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Justin August
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Ashley Visser
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Michael Mahler
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Michael H Weisman
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - James R O'Dell
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Richard M Keating
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Jane H Buckner
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Peter K Gregersen
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Jill M Norris
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - V Michael Holers
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Kevin D Deane
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - M Kristen Demoruelle
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA. .,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus.
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Sinnathurai P, Bartlett SJ, Halls S, Hewlett S, Orbai AM, Buchbinder R, Henderson L, Hill CL, Lassere M, March L. Investigating Dimensions of Stiffness in Rheumatoid and Psoriatic Arthritis: The Australian Rheumatology Association Database Registry and OMERACT Collaboration. J Rheumatol 2019; 46:1462-1469. [PMID: 30936277 DOI: 10.3899/jrheum.181251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE It is not known how the experience of stiffness varies between diagnoses or how best to measure stiffness. The aims of our study were to (1) compare stiffness in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) using patient-reported outcomes, (2) investigate how dimensions of stiffness are associated with each other and reflect the patient experience, and (3) analyze how different dimensions of stiffness are associated with physical function. METHODS An online survey was sent to Australian Rheumatology Association Database participants (158 PsA, and 158 age- and sex-matched RA), assessing stiffness severity, duration, impact, importance, coping, and physical function [modified Health Assessment Questionnaire (mHAQ)]. Scores were compared between diagnoses and correlations among stiffness dimensions calculated. Multivariate regression was performed for stiffness severity, impact, and duration on mHAQ, adjusting for age, sex, disease duration, obesity, and pain. Cognitive debriefing was conducted through semistructured telephone interviews. RESULTS Overall, 240/316 (75.9%) responded [124/158 RA (78.5%) and 116/158 PsA (73.4%)], with no significant difference in stiffness ratings between diagnoses. Scores for all stiffness dimensions were strongly correlated (r = 0.52-0.89), and severity and impact were associated with mHAQ in both diagnoses. Stiffness duration was not associated with mHAQ in RA. In cognitive debriefing, participants described stiffness severity and impact by their effect on daily activities (10/16 and 14/16 participants, respectively). CONCLUSION Stiffness ratings were similar between PsA and RA. Different dimensions of stiffness were strongly correlated. Stiffness severity and impact both independently predicted mHAQ. Stiffness was important to participants; however, measuring multiple dimensions of stiffness may have minimal additive value.
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Affiliation(s)
- Premarani Sinnathurai
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK. .,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney.
| | - Susan J Bartlett
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Serena Halls
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Sarah Hewlett
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Ana-Maria Orbai
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Rachelle Buchbinder
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Lyndall Henderson
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Catherine L Hill
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Marissa Lassere
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
| | - Lyn March
- From the Institute of Bone and Joint Research, Kolling Institute; Rheumatology Department, Royal North Shore Hospital, St Leonards; Sydney Medical School, University of Sydney; School of Public Health and Community Medicine, University of New South Wales, Sydney; Monash Department of Clinical Epidemiology, Cabrini Institute; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne; Rheumatology Unit, The Queen Elizabeth Hospital; Discipline of Medicine, University of Adelaide, Adelaide; Rheumatology Department, St George Hospital, Kogarah, Australia; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Epidemiology, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Johns Hopkins Medicine, Baltimore, Maryland, USA; Department of Nursing and Midwifery, University of the West of England, Bristol, UK.,P. Sinnathurai, MBBS, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney; S.J. Bartlett, MD, Division of Clinical Epidemiology, Division of Rheumatology, and Division of Respiratory Epidemiology, McGill University/McGill University Health Centers, and Division of Rheumatology, Johns Hopkins School of Medicine; S. Halls, PhD, Department of Nursing and Midwifery, University of the West of England; S. Hewlett, PhD, Department of Nursing and Midwifery, University of the West of England; A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine; R. Buchbinder, PhD, Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; L. Henderson, MSc, University of Sydney; C.L. Hill, MD, Rheumatology Unit, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide; M. Lassere, PhD, School of Public Health and Community Medicine, University of New South Wales and Rheumatology Department, St George Hospital; L. March, PhD, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, and Department of Rheumatology, Royal North Shore Hospital, and University of Sydney
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Bruyn GAW, Siddle HJ, Hanova P, Costantino F, Iagnocco A, Delle Sedie A, Gutierrez M, Hammer HB, Jernberg E, Loeille D, Micu MC, Moller I, Pineda C, Richards B, Stoenoiu MS, Suzuki T, Terslev L, Vlad V, Wonink R, d'Agostino MA, Wakefield RJ. Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions. J Rheumatol 2019; 46:351-359. [PMID: 30385707 DOI: 10.3899/jrheum.171490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA). METHODS Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively. CONCLUSION Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.
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Affiliation(s)
- George A W Bruyn
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands.
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work.
| | - Heidi J Siddle
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Petra Hanova
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Félicie Costantino
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Annamaria Iagnocco
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Andrea Delle Sedie
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Marwin Gutierrez
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Hilde B Hammer
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Elizabeth Jernberg
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Damien Loeille
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Mihaela C Micu
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Ingrid Moller
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Carlos Pineda
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Bethan Richards
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Maria S Stoenoiu
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Takeshi Suzuki
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Lene Terslev
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Violeta Vlad
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Robert Wonink
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Maria-Antonietta d'Agostino
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
| | - Richard J Wakefield
- From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands
- G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work
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Zhu M, Yu B, Bai J, Wang X, Guo X, Liu Y, Lin J, Hu S, Zhang W, Tao Y, Hu C, Yang H, Xu Y, Geng D. Cannabinoid Receptor 2 Agonist Prevents Local and Systemic Inflammatory Bone Destruction in Rheumatoid Arthritis. J Bone Miner Res 2019; 34:739-751. [PMID: 30508319 DOI: 10.1002/jbmr.3637] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022]
Abstract
Cannabinoid receptor 2 (CB2) has been implicated as an important clinical regulator of inflammation and malignant osteolysis. Here, we observed that CB2 expression was markedly higher in the collagen-induced arthritis (CIA) mice synovium and bone tissues than in the noninflamed synovium and bone tissues. The CB2 selective agonist (JWH133) but not antagonist (SR144528) suppressed CIA in mice without toxic effects, as demonstrated by the decreased synovial hyperplasia, inflammatory responses, cartilage damage, and periarticular and systemic bone destruction. JWH133 treatment decreased the infiltration of pro-inflammatory M1-like macrophages and repolarized macrophages from the M1 to M2 phenotype. Similarly, activation of CB2 increased the expression of anti-inflammatory cytokine interleukin (IL)-10 and reduced the expression of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α), IL-1β, and IL-6. In addition, JWH133 treatment attenuated osteoclast formation and osteoclastic bone resorption, and reduced the expression of receptor activators of the nuclear factor-κB (NF-κB) ligand (RANKL), matrix metallopeptidase-9 (MMP-9), tartrate-resistant acid phosphatase (TRAP), cathepsin K (CTSK), and nuclear factor of activated T-cells 1 (NFAT-1) in CIA mice and osteoclast precursors, which were obviously blocked by pretreatment with SR144528. Mechanistically, JWH133 inhibited RANKL-induced NF-κB activation in the osteoclast precursors. We found that JWH133 ameliorates pathologic bone destruction in CIA mice via the inhibition of osteoclastogenesis and modulation of inflammatory responses, thereby highlighting its potential as a treatment for human rheumatoid arthritis. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Mo Zhu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Binqin Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaxiang Bai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaobin Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiayi Lin
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen Zhang
- Orthopedics Institute, Soochow University, Suzhou, China
| | - Yunxia Tao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yaozeng Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Sewerin P, Schleich C, Brinks R, Müller-Lutz A, Fichter F, Eichner M, Schneider M, Ostendorf B, Vordenbäumen S. Assessing Associations of Synovial Perfusion, Cartilage Quality, and Outcome in Rheumatoid Arthritis Using Dynamic Contrast-enhanced Magnetic Resonance Imaging. J Rheumatol 2019; 47:15-19. [PMID: 30877219 DOI: 10.3899/jrheum.180832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess associations of synovial perfusion, cartilage quality, and outcome in rheumatoid arthritis (RA). METHODS Synovial perfusion and cartilage quality were assessed by dynamic contrast-enhanced magnetic resonance imaging in metacarpophalangeal joints of 28 treatment-naive patients with RA at baseline and at 3 and 6 months after methotrexate. Analysis was by linear mixed modeling. RESULTS Synovial perfusion variables were associated with remission (p < 0.05) and cartilage quality (p < 0.004). Maximum synovial enhancement was associated to European League Against Rheumatism response (p < 0.05). Synovial perfusion improved in nonresponders over time (p < 0.05). CONCLUSION Synovial perfusion relates to remission, response, and cartilage quality in a cohort of therapy-naive patients with early RA.
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Affiliation(s)
- Philipp Sewerin
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany. .,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work.
| | - Christoph Schleich
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Ralph Brinks
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Anja Müller-Lutz
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Florian Fichter
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Markus Eichner
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Matthias Schneider
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Benedikt Ostendorf
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Stefan Vordenbäumen
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
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Gossec L, Strand V, Proudfoot C, Chen CI, Guillonneau S, Kimura T, van Hoogstraten H, Mangan E, Reaney M. Effects of Sarilumab on Rheumatoid Arthritis as Reported by Patients Using the Rheumatoid Arthritis Impact of Disease Scale. J Rheumatol 2019; 46:1259-1267. [PMID: 30877216 DOI: 10.3899/jrheum.180904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We evaluated the effect of sarilumab on patient-perceived impact of rheumatoid arthritis (RA) using the 7-domain RA Impact of Disease (RAID) scale. METHODS Two phase III, randomized, controlled trials of sarilumab in patients with active, longstanding RA were analyzed: (1) sarilumab 150 mg and 200 mg every 2 weeks plus conventional synthetic disease-modifying antirheumatic drugs (+csDMARD) versus placebo + csDMARD [TARGET (NCT01709578)]; and (2) sarilumab 200 mg versus adalimumab (ADA) 40 mg monotherapy [MONARCH (NCT02332590)]. Least-squares mean (LSM) differences in RAID total score (range 0-10) and 7 key RA symptoms, including pain and fatigue (baseline to Weeks 12 and 24), were compared. "Responders" by RAID total score were defined by improvements from baseline ≥ minimal clinically important difference (MCID), and ≥ patient-acceptable symptom-state (PASS) at endpoint. RESULTS Sarilumab 150 mg and 200 mg + csDMARD were nominally superior (p < 0.05) versus placebo + csDMARD and 200 mg sarilumab versus ADA 40 mg in LSM differences for RAID total score at weeks 12 (-0.93 and -1.13; -0.49, respectively) and 24 (-0.75 and -1.01; -0.78), and all effects of RA (except functional impairment in MONARCH Week 12). Effects were greater in physical domains (e.g., pain) than mental domains (e.g., emotional well-being). More patients receiving sarilumab versus placebo or ADA reported improvements ≥ MCID and PASS in total RAID scores at both assessments. CONCLUSION Based on the RAID, sarilumab + csDMARD or as monotherapy reduced the effect of RA on patients' lives to a greater extent than placebo + csDMARD or ADA monotherapy. (ClinicalTrials.gov: NCT01709578 and NCT02332590).
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Affiliation(s)
- Laure Gossec
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Vibeke Strand
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Clare Proudfoot
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Chieh-I Chen
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Sophie Guillonneau
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Toshio Kimura
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Hubert van Hoogstraten
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Erin Mangan
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Matthew Reaney
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA. .,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi.
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Malochet-Guinamand S, Lambert C, Gossec L, Soubrier M, Dougados M. Evaluation of the Implementation of Guidelines on the Treatment of Osteoporosis in Patients with Rheumatoid Arthritis. J Rheumatol 2019; 47:6-14. [PMID: 30877214 DOI: 10.3899/jrheum.180889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess whether the 2003 and 2014 French guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) and the 2012 update of the French guidelines for the treatment of postmenopausal osteoporosis (PMOP) were applied in patients with rheumatoid arthritis (RA). METHODS We conducted a cross-sectional study of 776 patients with RA (19 centers). We collected the data required for the application of the various recommendations (age, sex, prednisone intake, low-energy fracture, history in the immediate family of hip fractures, and bone densitometry), anti-osteoporotic drugs, and the various factors that may be associated with the application of the recommendations. RESULTS Of the patients who should have received antiosteoporosis treatment, there were 22.6% actually treated (according to the 2014 guidelines), 27.3% actually treated according to the 2003 guidelines, and of postmenopausal women, 23.6% (according to the 2012 PMOP guidelines). Applying the 2014 GIOP guidelines increased the theoretical number of patients requiring treatment relative to the 2003 GIOP guidelines (77% vs 53%; p < 0.001). In multivariate analysis, being treated was associated with a spinal T score ≤ -2 SD according to the 2014 guidelines; with not taking part in physical activity for more than 30 min a day according to the 2003 guidelines; and with older age, lower body mass index, and a T score ≤ -2.5 SD in at least 1 site according to the PMOP guidelines. CONCLUSION Patients with RA had inadequate prevention of GIOP and PMOP. The management of osteoporosis needs to be improved in this population.
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Affiliation(s)
- Sandrine Malochet-Guinamand
- From the Rheumatology Department, and Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Auvergne; Sorbonne University; Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University; Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France. .,S. Malochet-Guinamand, MD, University Hospital Clermont-Ferrand, Rheumatology Department; C. Lambert, MSc, University Hospital Clermont-Ferrand, Biostatistics Unit (DRCI); L. Gossec, PhD, Sorbonne University, and Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; M. Soubrier, PhD, University Hospital Clermont-Ferrand, Rheumatology Department; M. Dougados, PhD, Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University, and Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité.
| | - Céline Lambert
- From the Rheumatology Department, and Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Auvergne; Sorbonne University; Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University; Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France.,S. Malochet-Guinamand, MD, University Hospital Clermont-Ferrand, Rheumatology Department; C. Lambert, MSc, University Hospital Clermont-Ferrand, Biostatistics Unit (DRCI); L. Gossec, PhD, Sorbonne University, and Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; M. Soubrier, PhD, University Hospital Clermont-Ferrand, Rheumatology Department; M. Dougados, PhD, Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University, and Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité
| | - Laure Gossec
- From the Rheumatology Department, and Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Auvergne; Sorbonne University; Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University; Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France.,S. Malochet-Guinamand, MD, University Hospital Clermont-Ferrand, Rheumatology Department; C. Lambert, MSc, University Hospital Clermont-Ferrand, Biostatistics Unit (DRCI); L. Gossec, PhD, Sorbonne University, and Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; M. Soubrier, PhD, University Hospital Clermont-Ferrand, Rheumatology Department; M. Dougados, PhD, Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University, and Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité
| | - Martin Soubrier
- From the Rheumatology Department, and Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Auvergne; Sorbonne University; Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University; Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France.,S. Malochet-Guinamand, MD, University Hospital Clermont-Ferrand, Rheumatology Department; C. Lambert, MSc, University Hospital Clermont-Ferrand, Biostatistics Unit (DRCI); L. Gossec, PhD, Sorbonne University, and Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; M. Soubrier, PhD, University Hospital Clermont-Ferrand, Rheumatology Department; M. Dougados, PhD, Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University, and Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité
| | - Maxime Dougados
- From the Rheumatology Department, and Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Auvergne; Sorbonne University; Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University; Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France.,S. Malochet-Guinamand, MD, University Hospital Clermont-Ferrand, Rheumatology Department; C. Lambert, MSc, University Hospital Clermont-Ferrand, Biostatistics Unit (DRCI); L. Gossec, PhD, Sorbonne University, and Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; M. Soubrier, PhD, University Hospital Clermont-Ferrand, Rheumatology Department; M. Dougados, PhD, Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University, and Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité
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Lopez-Olivo MA, Negrón JB, Zogala RJ, Carmona L, Criner K, Goel N, Gonzalez-Lopez L, Ingegnoli F, Leong A, March L, Shea B, Strand V, Tugwell P, Westrich-Robertson T, Zamora NV, Christensen R, Suarez-Almazor ME. Core Outcome Sets Specifically for Longterm Observational Studies: OMERACT Special Interest Group Update in Rheumatoid Arthritis. J Rheumatol 2019; 46:1164-1167. [PMID: 30824644 DOI: 10.3899/jrheum.181076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This is an update from the Outcome Measures in Rheumatology (OMERACT) Core Outcomes in Longterm Observational Studies Special Interest Group with a focus on rheumatoid arthritis. METHODS Preliminary data and proposed next steps were outlined and discussed by participants. RESULTS Domains identified after initial steps (systematic review and qualitative research) were pain, physical functioning, participation (i.e., work, social), longterm symptoms, fertility/family planning, emotional well-being, coping, financial status, and adverse events including death. CONCLUSION The group agreed conceptually that short-term core outcomes could be different from longer term ones. Participants emphasized the importance of analyzing the need for core domains specifically for longterm longitudinal observational studies.
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Affiliation(s)
- Maria A Lopez-Olivo
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - José B Negrón
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Richard J Zogala
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Loreto Carmona
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Karla Criner
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Niti Goel
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Laura Gonzalez-Lopez
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Francesca Ingegnoli
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Amye Leong
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Lyn March
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Beverly Shea
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Vibeke Strand
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Peter Tugwell
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Tiffany Westrich-Robertson
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Natalia V Zamora
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Robin Christensen
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark.,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center
| | - Maria E Suarez-Almazor
- From the Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine, Houston, Texas; Kezar Life Sciences, San Francisco; Healthy Motivation, Santa Barbara; Division of Immunology and Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina; International Foundation for Autoimmune and Autoinflammatory Arthritis, St. Louis, Missouri, USA; Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Truro, Cornwall, UK; Instituto de Salud Musculoesqueletica, Madrid, Spain; Universidad de Guadalajara, Guadalajara, Mexico; Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano, Milan, Italy; Institute of Bone and Joint Research, Sydney Medical School, University of Sydney, Sydney, Australia; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Instituto de Rehabilitacion Psicofisica, Buenos Aires, Argentina; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark. .,M.A. Lopez-Olivo, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; J.B. Negrón, MSc, Instituto de Salud Musculoesqueletica; R.J. Zogala, MD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center; L. Carmona, MD, PhD, Instituto de Salud Musculoesqueletica; K. Criner, MD, Department of Medicine-Immunology, Allergy & Rheumatology, Baylor College of Medicine; N. Goel, MD, PhD, Kezar Life Sciences, and Division of Rheumatology, Duke University School of Medicine; L. Gonzalez-Lopez, MD, MSc, PhD, Universidad de Guadalajara; F. Ingegnoli, MD, PhD, Division of Clinical Rheumatology, G. Pini Hospital, Università degli Studi di Milano; A. Leong, MBA, Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade; L. March, MBBS, MSc, PhD, FRACP, FAFPHM, Institute of Bone and Joint Research, Sydney Medical School, University of Sydney; B. Shea, PhD, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; V. Strand, MD, MACR, FACP, Biopharmaceutical Consultant, Portola Valley, California, USA; P. Tugwell, OC, MD, FRCPC, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; T. Westrich-Robertson, BS, International Foundation for Autoimmune and Autoinflammatory Arthritis; N.V. Zamora, MD, Instituto de Rehabilitacion Psicofisica; R. Christensen, MSc, PhD, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; M.E. Suarez-Almazor, MD, PhD, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center.
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Zhao M, Mauer L, Sayles H, Cannon GW, Reimold A, Kerr GS, Baker JF, Thiele GM, England BR, Mikuls TR. HLA-DRB1 Haplotypes, Shared Epitope, and Disease Outcomes in US Veterans with Rheumatoid Arthritis. J Rheumatol 2019; 46:685-693. [PMID: 30824656 DOI: 10.3899/jrheum.180724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate associations of HLA-DRB1 haplotypes and shared epitope (SE) with rheumatoid arthritis (RA) severity and all-cause mortality in RA. METHODS Patients with RA from the Veterans Affairs Rheumatoid Arthritis (VARA) registry were followed from enrollment until death or December 31, 2013. Clinical characteristics, DNA, and serum were collected at enrollment. Radiographic damage, the presence or absence of subcutaneous nodules, disease activity measures, and functional status were assessed at enrollment and updated during followup. Sixteen HLA-DRB1 haplotypes and SE status were determined from banked DNA. Associations between HLA-DRB1 haplotypes, RA disease characteristics, and mortality were assessed in multivariable regression models. RESULTS Within VARA, 1443 participants had genotyping and accrued 6150 patient-years of followup. Haplotypes VKA, VRA, LRA, SRA, SRE, SKR, and SEA, and SE alleles were significantly associated with seropositivity for rheumatoid factor (RF) and/or anticyclic citrullinated peptide (anti-CCP). Haplotypes VKA and SKR were associated with higher RF concentrations, while VRA, DRE, and GRQ were associated with lower RF concentrations. Haplotypes VKA, VRA, and LRA were associated with higher concentrations of anti-CCP antibody, while haplotypes SRA, SRE, LEA, SKR, and SEA were significantly associated with lower anti-CCP concentrations. Haplotype VKA (OR 1.39, 95% CI 1.08-1.80) was associated with increased frequency of radiographic damage at enrollment but none of the haplotypes were associated with the presence of subcutaneous nodules. Haplotypes SKA (HR 1.52, 95% CI 1.26-1.83) was associated with higher mortality. CONCLUSION HLA-DRB1 haplotypes are independently and variably associated with seropositivity, autoantibody concentrations, and outcomes in RA.
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Affiliation(s)
- Ming Zhao
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Lilli Mauer
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Harlan Sayles
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Grant W Cannon
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Andreas Reimold
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Gail S Kerr
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Joshua F Baker
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Geoffrey M Thiele
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Bryant R England
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Ted R Mikuls
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA. .,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC.
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Sundin U, Østergaard M, Glinatsi D, Aga AB, Hørslev-Petersen K, Hetland ML, Stengard-Pedersen K, Junker P, Ejbjerg BJ, Bird P, Conaghan PG, Lillegraven S, Haavardsholm EA. Validity and Responsiveness of Combined Inflammation and Combined Joint Damage Scores Based on the OMERACT Rheumatoid Arthritis MRI Scoring System (RAMRIS). J Rheumatol 2019; 46:1222-1227. [PMID: 30770509 DOI: 10.3899/jrheum.181064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The RAMRIS [Outcome Measures in Rheumatology rheumatoid arthritis (RA) magnetic resonance imaging (MRI) Scoring system] is used in clinical RA trials. We have investigated methods to combine the RAMRIS features into valid and responsive scores for inflammation and joint damage. METHODS We used data from 3 large randomized early RA trials to assess 5 methods to develop a combined score for inflammation based on RAMRIS bone marrow edema, synovitis, and tenosynovitis scores, and a combined joint damage score based on erosions and joint space narrowing. Methods included unweighted summation, normalized summation, and 3 different variants of weighted summation of the RAMRIS features. We used a derivation cohort to calculate summation weights to maximize the responsiveness of the combined score. Construct validity of the combined scores was examined by assessing correlations to imaging, clinical, and biochemical measures. Responsiveness was tested by calculating the standardized response mean (SRM) and the relative efficiency of each score in a validation cohort. RESULTS Patient characteristics, as well as baseline and followup RAMRIS scores, were comparable between cohorts. All combined scores were significantly correlated to other imaging, clinical, and biochemical measures. Inflammation scores combined by normalized and weighted summation had significantly higher responsiveness in comparison to unweighted summation, with SRM (95% CI) for unweighted summation 0.62 (0.51-0.73), normalized summation 0.73 (0.63-0.83), and weighted summation 0.74 (0.64-0.84). For the damage score, there was a trend toward higher responsiveness for weighted summation. CONCLUSION Combined MRI scores calculated by normalized or weighted summation of individual MRI pathologies were valid and responsive.
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Affiliation(s)
- Ulf Sundin
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK. .,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo.
| | - Mikkel Østergaard
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Daniel Glinatsi
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Anna-Birgitte Aga
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Kim Hørslev-Petersen
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Merete L Hetland
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Kristian Stengard-Pedersen
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Peter Junker
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Bo J Ejbjerg
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Paul Bird
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Philip G Conaghan
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Siri Lillegraven
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Espen A Haavardsholm
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
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Pickles T, Alten R, Boers M, Bykerk V, Christensen J, Christensen R, van Hoogstraten H, Simon LS, Tam LS, Choy EH. Adaptive Trial Designs in Rheumatology: Report from the OMERACT Special Interest Group. J Rheumatol 2019; 46:1406-1408. [PMID: 30770514 DOI: 10.3899/jrheum.181054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Adaptive trial design was developed initially for oncology to improve trial efficiency. If optimized for rheumatology, it may improve trial efficiency by reducing sample size and time. METHODS A systematic review assessed design of phase II clinical trials in rheumatoid arthritis. RESULTS Fifty-six trials were reviewed. Most trials had 4 groups (1 control and 3 intervention), with an average group size of 34 patients. American College of Rheumatology 20 measured at 16 weeks was the most commonly used primary endpoint. CONCLUSION The next step is to undertake a systematic review of adaptive designs used in early-phase trials in nonrheumatic conditions.
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Affiliation(s)
- Tim Pickles
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Rieke Alten
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Maarten Boers
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Vivian Bykerk
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Jared Christensen
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Robin Christensen
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Hubert van Hoogstraten
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Lee S Simon
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Lai-Shan Tam
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University
| | - Ernest H Choy
- From the CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK; Schlosspark Klinik, Charité University Medicine, Berlin, Germany; Department of Epidemiology and Biostatistics; Amsterdam Rheumatology and Immunology Center; Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College; Pfizer, New York, New York; Sanofi, Bridgewater, New Jersey; SDG LLC, Cambridge, Massachusetts, USA; Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department of Rheumatology, Odense University Hospital, Odense, Denmark; Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. .,T. Pickles, MSc, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University; R. Alten, MD, PhD, Schlosspark Klinik, Charité University Medicine; M. Boers, MD, PhD, MSc, Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, and Amsterdam University Medical Centers VUmc; V. Bykerk, MD, FRCPC, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, and Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J. Christensen, MD, Pfizer; R. Christensen, PhD, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and Department of Rheumatology, Odense University Hospital; H. van Hoogstraten, MD, PhD, Sanofi; L.S. Simon, MD, SDG LLC; L.S. Tam, MD, Division of Rheumatology, Department of Medicine and Therapeutics, and Faculty of Medicine, The Chinese University of Hong Kong; E.H. Choy, MD, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University.
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Hambardzumyan K, Bolce RJ, Wallman JK, van Vollenhoven RF, Saevarsdottir S. Serum Biomarkers for Prediction of Response to Methotrexate Monotherapy in Early Rheumatoid Arthritis: Results from the SWEFOT Trial. J Rheumatol 2019; 46:555-563. [PMID: 30709958 DOI: 10.3899/jrheum.180537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate baseline levels of 12 serum biomarkers that constitute a multibiomarker disease activity test, as predictors of response to methotrexate (MTX) in patients with early rheumatoid arthritis (eRA). METHODS In 298 patients from the Swedish Pharmacotherapy (SWEFOT) clinical trial, baseline serum levels of 12 proteins were analyzed for association with disease activity based on the 28-joint count Disease Activity Score (DAS28) after 3 months of MTX monotherapy using uni-/multivariate logistic regression. Primary outcome was low disease activity (LDA; DAS28 ≤ 3.2). RESULTS Of 298 patients, 104 achieved LDA after 3 months on MTX. Four of the 12 biomarkers [C-reactive protein (CRP), leptin, tumor necrosis factor receptor I (TNF-RI), and vascular cell adhesion molecule 1 (VCAM-1)] significantly predicted LDA based on stepwise logistic regression analysis. Dichotomization of patients using receiver-operating characteristic curve analysis-based cutoffs for these biomarkers showed significantly higher proportions with LDA among patients with lower versus higher levels of CRP or leptin (40% vs 23%, p = 0.004, and 40% vs 25%, p = 0.011, respectively), as well as among those with higher versus lower levels of TNF-RI or VCAM-1 (43% vs 27%, p = 0.004, and 41% vs 25%, p = 0.004, respectively). Combined score based on these biomarkers, adjusted for known predictors of LDA (smoking, sex, and age), associated with decreased chance of LDA (adjusted OR 0.45, 95% CI 0.32-0.62). CONCLUSION Low baseline levels of CRP and leptin, and high baseline levels of TNF-RI and VCAM-1 were associated with LDA after 3 months of MTX therapy in patients with eRA. Combination of these 4 biomarkers increased accuracy of prediction. [Trial registration number: NCT00764725].
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Affiliation(s)
- Karen Hambardzumyan
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Rebecca J Bolce
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Johan K Wallman
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Ronald F van Vollenhoven
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Saedis Saevarsdottir
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden. .,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet.
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Peterfy C, DiCarlo J, Emery P, Genovese MC, Keystone EC, Taylor PC, Schlichting DE, Beattie SD, Luchi M, Macias W. MRI and Dose Selection in a Phase II Trial of Baricitinib with Conventional Synthetic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis. J Rheumatol 2019; 46:887-895. [PMID: 30647190 DOI: 10.3899/jrheum.171469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) was used in a phase IIb study of baricitinib in patients with RA to support dose selection for the phase III program. METHODS Three hundred one patients with active RA who were taking stable methotrexate were randomized 2:1:1:1:1 to placebo or once-daily baricitinib (1, 2, 4, or 8 mg) for up to 24 weeks. One hundred fifty-four patients with definitive radiographic erosion had MRI of the hand/wrist at baseline and at weeks 12 and 24. Two expert radiologists, blinded to treatment and visit order, scored images for synovitis, osteitis, bone erosion, and cartilage loss. Combined inflammation (osteitis + 3× synovitis score) and total joint damage (erosion + 2.5× cartilage loss score) scores were calculated. Treatment groups were compared using ANCOVA adjusting for baseline scores. RESULTS Mean changes from baseline to Week 12 for synovitis were -0.10, -1.50, and -1.60 for patients treated with placebo, baricitinib 4 mg, and baricitinib 8 mg, respectively (p = 0.003 vs placebo for baricitinib 4 and 8 mg). Mean changes for osteitis were 0.00, -3.20, and -2.10 (p = 0.001 vs placebo for baricitinib 4 mg and p = 0.037 for 8 mg), respectively. Mean changes for bone erosion were 0.90, 0.10, and 0.40 (p = 0.089 for 4 mg and p = 0.275 for 8 mg), respectively, in these treatment groups. CONCLUSION MRI findings in this subgroup of patients suggest suppression of synovitis, osteitis, and combined inflammation by baricitinib 4 and 8 mg. This corroborates previously demonstrated clinical efficacy of baricitinib and increases confidence that baricitinib 4 mg could reduce the radiographic progression in phase III studies. [Clinical trial registration number (www.ClinicalTrials.gov): NCT01185353].
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Affiliation(s)
- Charles Peterfy
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada. .,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co.
| | - Julie DiCarlo
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Paul Emery
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Mark C Genovese
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Edward C Keystone
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Peter C Taylor
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Doug E Schlichting
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Scott D Beattie
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Monica Luchi
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - William Macias
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
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Miura Y, Ota S, Peterlin M, McDevitt G, Kanazawa S. A Subpopulation of Synovial Fibroblasts Leads to Osteochondrogenesis in a Mouse Model of Chronic Inflammatory Rheumatoid Arthritis. JBMR Plus 2019; 3:e10132. [PMID: 31346564 DOI: 10.1002/jbm4.10132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/10/2018] [Accepted: 11/22/2018] [Indexed: 01/22/2023] Open
Abstract
Specific major histocompatibility complex (MHC) class II genes result in a high susceptibility to rheumatoid arthritis (RA), with co-stimulatory molecules working together with MHC class II during the progression of the disease. To elucidate the involvement of the B7.1 co-stimulatory molecule in RA, we analyzed the phenotype of B7.1 transgenic (named D1BC) mice and the sequential differentiation of synovial fibroblasts (SFs) by studying the expression of chondrogenic and osteogenic lineage markers together with lineage tracing experiment using B7.1 transgene in vivo. The B7.1 transgene was driven by a collagen type II (CII) promoter and enhancer in the D1BC mouse. A low-dose of bovine CII (bCII) was used to induce chronic articular inflammation with interstitial pneumonitis. Joint damage was analyzed by histopathological examination and computed tomography. B7.1 was expressed in articular cartilage and SFs of D1BC mice. Chronic inflammatory arthritis in the bCII-D1BC mouse shared common features with those found in patients with RA, such as pannus formation, bone destruction, osteoporosis, and joint ankylosis. A subpopulation of SFs (Runx2 +, Sox9 +, Col10a1 +, Osx+, and CX-) in the pannus was classified as osteochondrogenic lineage rather than mesenchymal stromal lineage. These cells underwent differentiation into osteogenic lineage via hypertrophic chondrocytes at the end of the chronic phase. The ectopic expression of B7.1 in chondrocytes and SFs leads to an increased susceptibility to chronic inflammatory arthritis and subsequent new bone formation, reminiscent of ankylosis. The regulation of cartilage remodeling in pannus tissue is an important consideration in the treatment of RA.
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Affiliation(s)
- Yoko Miura
- Department of Molecular and Cellular Biology Nagoya City University Graduate School of Medical Sciences Nagoya Aichi Japan
| | - Shusuke Ota
- Department of Orthopaedic Surgery Shizuoka Medical Center National Hospital Organization Suntou-gun Shizuoka Japan
| | - Matija Peterlin
- Departments of Medicine Microbiology and Immunology University of California San Francisco, San Francisco CA USA
| | - Grete McDevitt
- Department of Microbiology and immunology Stanford University School of Medicine Stanford CA USA
| | - Satoshi Kanazawa
- Department of Molecular and Cellular Biology Nagoya City University Graduate School of Medical Sciences Nagoya Aichi Japan
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Manske SL, Brunet SC, Finzel S, Stok KS, Conaghan PG, Boyd SK, Barnabe C. The SPECTRA Collaboration OMERACT Working Group: Construct Validity of Joint Space Outcomes with High-resolution Peripheral Quantitative Computed Tomography. J Rheumatol 2019; 46:1369-1373. [PMID: 30647172 DOI: 10.3899/jrheum.180870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We assessed construct validity of high-resolution peripheral quantitative computed tomography (HR-pQCT) joint space outcomes by comparison with radiographs in patients with rheumatoid arthritis. METHODS In 43 patients, quantitative, volumetric, HR-pQCT measurements were compared with ordinal Sharp/van der Heijde scoring (SvdH) in the 2nd and 3rd metacarpophalangeal joints. RESULTS Generalized estimating equations showed that joint space minimum, SD, and asymmetry by HR-pQCT were associated with SvdH scores (p < 0.05). There was a considerable range in HR-pQCT measurements at SvdH equal to 0. CONCLUSION HR-pQCT demonstrated construct validity outcomes and provides improved 3-D visualization of joint space.
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Affiliation(s)
- Sarah L Manske
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK. .,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.
| | - Scott C Brunet
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Stephanie Finzel
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Kathryn S Stok
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Philip G Conaghan
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Steven K Boyd
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Cheryl Barnabe
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
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Luque Ramos A, Redeker I, Hoffmann F, Callhoff J, Zink A, Albrecht K. Comorbidities in Patients with Rheumatoid Arthritis and Their Association with Patient-reported Outcomes: Results of Claims Data Linked to Questionnaire Survey. J Rheumatol 2019; 46:564-571. [PMID: 30647170 DOI: 10.3899/jrheum.180668] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the prevalence of comorbidities in a population-based cohort of persons with rheumatoid arthritis (RA) compared to matched controls and to examine their association with patient-reported outcomes in a survey sample. METHODS Data of 96,921 persons with RA [International Classification of Diseases, 10th ed (ICD-10) M05/M06] and 484,605 age- and sex-matched controls without RA of a German statutory health fund were studied regarding 26 selected comorbidities (ICD-10). A self-reported questionnaire, comprising joint counts [(tender joint count (TJC), swollen joint count (SJC)], functional status (Hannover Functional Ability Questionnaire), effect of the disease (Rheumatoid Arthritis Impact of Disease), and well-being (World Health Organization 5-item Well-Being Index; WHO-5) was sent to a random sample of 6193 persons with RA, of whom 3184 responded. For respondents who confirmed their RA (n = 2535), associations between comorbidities and patient-reported outcomes were analyzed by multivariable linear regression. RESULTS Compared to controls, all investigated comorbidities were more frequent in persons with RA (mean age 63 yrs, 80% female). In addition to cardiovascular risk factors, the most common were osteoarthritis (44% vs 21%), depression (32% vs 20%), and osteoporosis (26% vs 9%). Among the survey respondents, 87% of those with 0-1 comorbidity but only 77% of those with ≥ 8 comorbidities were treated by rheumatologists. Increasing numbers of comorbidities were associated with poorer values for TJC, SJC, function, and WHO-5. CONCLUSION Compared to a matched population, persons with RA present with increased prevalence of numerous comorbidities. Patients with RA and multimorbidity are at risk of insufficient rheumatological care and poorer patient-reported outcomes.
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Affiliation(s)
- Andres Luque Ramos
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany. .,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre.
| | - Imke Redeker
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Falk Hoffmann
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Johanna Callhoff
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Angela Zink
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
| | - Katinka Albrecht
- From the Department for Health Services Research, Carl von Ossietzky University, Oldenburg; Epidemiology, German Rheumatism Research Centre, Berlin; Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany.,A. Luque Ramos, MPH, Department for Health Services Research, Carl von Ossietzky University; I. Redeker, MSc, Epidemiology, German Rheumatism Research Centre; F. Hoffmann, Professor, Department for Health Services Research, Carl von Ossietzky University; J. Callhoff, MSc, Epidemiology, German Rheumatism Research Centre; A. Zink, Professor, Epidemiology, German Rheumatism Research Centre, and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin; K. Albrecht, MD, Epidemiology, German Rheumatism Research Centre
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Gianfrancesco MA, Trupin L, Shiboski S, van der Laan M, Graf J, Imboden J, Yazdany J, Schmajuk G. Smoking Is Associated with Higher Disease Activity in Rheumatoid Arthritis: A Longitudinal Study Controlling for Time-varying Covariates. J Rheumatol 2018; 46:370-375. [PMID: 30504507 DOI: 10.3899/jrheum.180262] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Prior studies around the relationship between smoking and rheumatoid arthritis (RA) disease activity have reported inconsistent findings, which may be ascribed to heterogeneous study designs or biases in statistical analyses. We examined the association between smoking and RA outcomes using statistical methods that account for time-varying confounding and loss to followup. METHODS We included 282 individuals with an RA diagnosis using electronic health record data collected at a public hospital between 2013 and 2017. Current smoking status and disease activity were assessed at each visit; covariates included sex, race/ethnicity, age, obesity, and medication use. We used longitudinal targeted maximum likelihood estimation to estimate the causal effect of smoking on disease activity measures at 27 months, and compared results to conventional longitudinal methods. RESULTS Smoking was associated with an increase of 0.64 units in the patient global score compared to nonsmoking (p = 0.01), and with 2.58 more swollen joints (p < 0.001). While smoking was associated with a higher clinical disease activity score (2.11), the difference was not statistically significant (p = 0.22). We found no association between smoking and physician global score, or C-reactive protein levels, and an inverse association between smoking and tender joint count (p = 0.05). Analyses using conventional methods showed a null relationship for all outcomes. CONCLUSION Smoking is associated with higher levels of disease activity in RA. Causal methods may be useful for investigations of additional exposures on longitudinal outcome measures in rheumatologic disease.
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Affiliation(s)
- Milena A Gianfrancesco
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA. .,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA.
| | - Laura Trupin
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Stephen Shiboski
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Mark van der Laan
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jonathan Graf
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - John Imboden
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jinoos Yazdany
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Gabriela Schmajuk
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
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Hagen M, Englbrecht M, Haschka J, Reiser M, Kleyer A, Hueber A, Manger B, Figueiredo C, Cobra JF, Tony HP, Finzel S, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Lorenz HM, Nüsslein H, Alten R, Henes J, Krüger K, Schett G, Rech J. Cost-effective Tapering Algorithm in Patients with Rheumatoid Arthritis: Combination of Multibiomarker Disease Activity Score and Autoantibody Status. J Rheumatol 2018; 46:460-466. [PMID: 30504510 DOI: 10.3899/jrheum.180028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze the effect of a risk-stratified disease-modifying antirheumatic drug (DMARD)-tapering algorithm based on multibiomarker disease activity (MBDA) score and anticitrullinated protein antibodies (ACPA) on direct treatment costs for patients with rheumatoid arthritis (RA) in sustained remission. METHODS The study was a posthoc retrospective analysis of direct treatment costs for 146 patients with RA in sustained remission tapering and stopping DMARD treatment, in the prospective randomized RETRO study. MBDA scores and ACPA status were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and direct treatment costs were evaluated every 3 months. MBDA and ACPA status were used as predictors creating a risk-stratified tapering algorithm based on relapse rates. RESULTS RA patients with a low MBDA score (< 30 units) and negative ACPA showed the lowest relapse risk (19%), while double-positive patients showed high relapse risk (61%). In ACPA-negative and MBDA-negative (< 30 units), and ACPA or MBDA single-positive (> 30 units) groups, DMARD tapering appears feasible. Considering only patients without flare, direct costs for synthetic and biologic DMARD in the ACPA/MBDA-negative and single positive groups (n = 41) would have been €372,245.16 for full-dose treatment over 1 year. Tapering and stopping DMARD in this low-risk relapse group allowed a reduction of €219,712.03 of DMARD costs. Average reduction of DMARD costs per patient was €5358.83. CONCLUSION Combining MBDA score and ACPA status at baseline may allow risk stratification for successful DMARD tapering and cost-effective use of biologic DMARD in patients in deep remission as defined by the 28-joint count Disease Activity Score using erythrocyte sedimentation rate.
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Affiliation(s)
- Melanie Hagen
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Matthias Englbrecht
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Judith Haschka
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Michaela Reiser
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Arnd Kleyer
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Axel Hueber
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Bernhard Manger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Camille Figueiredo
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jayme Fogagnolo Cobra
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Hans-Peter Tony
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Stephanie Finzel
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Stefan Kleinert
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jörg Wendler
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Florian Schuch
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Monika Ronneberger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Martin Feuchtenberger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Martin Fleck
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Karin Manger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Wolfgang Ochs
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Hans-Martin Lorenz
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Hubert Nüsslein
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Rieke Alten
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jörg Henes
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Klaus Krüger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Georg Schett
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jürgen Rech
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. .,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen.
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Widdifield J, Abrahamowicz M, Paterson JM, Huang A, Thorne JC, Pope JE, Kuriya B, Beauchamp ME, Bernatsky S. Associations Between Methotrexate Use and the Risk of Cardiovascular Events in Patients with Elderly-onset Rheumatoid Arthritis. J Rheumatol 2018; 46:467-474. [PMID: 30504508 DOI: 10.3899/jrheum.180427] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We evaluated the associations between time-varying methotrexate (MTX) use and risk of cardiovascular events (CVE) in patients with rheumatoid arthritis (RA). METHODS We studied an inception cohort of 23,994 patients with RA diagnosed after their 65th birthday. Multivariable Cox regression models were fit to evaluate the associations between time-varying MTX use, controlling for other risk factors, and time to CVE. Alternative models assessed the cumulative duration of MTX use over the (1) first year, (2) previous year (recent use), and (3) entire duration of followup. We also assessed whether the strength of the association varied over time. RESULTS Over 115,453 patient-years (PY), 3294 (13.7%) patients experienced a CVE (28.5 events per 1000 PY; 95% CI 27.6-29.5). In the multivariable analyses, the model assessing time-varying continuous use in the most recent year yielded the best fit. Increasing recent MTX use was associated with lower CVE risks (HR 0.79 for continuous use vs no use in past 12 months, 95% CI 0.70-0.88; p < 0.0001). Greater MTX use in the first year after cohort entry was also protective (HR 0.84, 95% CI 0.72-0.96; p = 0.0048), but this effect decreased with increasing followup. In contrast, longer MTX use during the entire followup was not clearly associated with CVE risk (HR 0.98, 95% CI 0.95-1.01; p = 0.1441). CONCLUSION We observed about a 20% decrease in CVE associated with recent continuous MTX use. Greater MTX use in the first year of cohort entry also appeared to be important in the association between MTX and CVE risk.
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Affiliation(s)
- Jessica Widdifield
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada. .,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation.
| | - Michal Abrahamowicz
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - J Michael Paterson
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Anjie Huang
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - J Carter Thorne
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Janet E Pope
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Bindee Kuriya
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Marie-Eve Beauchamp
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Sasha Bernatsky
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
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Curtis JR, Xie F, Yang S, Danila MI, Owensby JK, Chen L. Uptake and Clinical Utility of Multibiomarker Disease Activity Testing in the United States. J Rheumatol 2018; 46:237-244. [PMID: 30442830 PMCID: PMC6411282 DOI: 10.3899/jrheum.180071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The clinical utility of the multibiomarker disease activity (MBDA) test for rheumatoid arthritis (RA) management in routine care in the United States has not been thoroughly studied. METHODS Using 2011-2015 Medicare data, we linked each patient with RA to their MBDA test result. Initiation of a biologic or Janus kinase (JAK) inhibitor in the 6 months following MBDA testing was described. Multivariable adjustment evaluated the likelihood of adding or switching biologic/JAK inhibitor, controlling for potential confounders. For patients with high MBDA scores who added a new RA therapy and were subsequently retested, lack of improvement in the MBDA score was evaluated as a predictor of future RA medication failure, defined by the necessity to change RA medications again. RESULTS Among 60,596 RA patients with MBDA testing, the proportion adding or switching biologics/JAK inhibitor among those not already taking a biologic/JAK inhibitor was 9.0% (low MBDA), 11.8% (moderate MBDA), and 19.7% (high MBDA, p < 0.0001). Similarly, among those already taking biologics/JAK inhibitor, the proportions were 5.2%, 8.3%, and 13.5% (p < 0.0001). After multivariable adjustment, referent to those with low disease MBDA scores, the likelihood of switching was 1.51-fold greater (95% CI 1.35-1.69) for patients with moderate MBDA scores, and 2.62 (2.26-3.05) for patients with high MBDA scores. Among those with high MBDA scores who subsequently added a biologic/JAK inhibitor and were retested, lack of improvement in the MBDA score category was associated with likelihood of future RA treatment failure (OR 1.61, 95% CI 1.27-2.03). CONCLUSION The MBDA score was associated with both biologic and JAK inhibitor medication addition/switching and subsequent treatment outcomes.
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Affiliation(s)
- Jeffrey R Curtis
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA. .,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; F. Xie, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; S. Yang, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M.I. Danila, MD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.K. Owensby, PharmD, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham.
| | - Fenglong Xie
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; F. Xie, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; S. Yang, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M.I. Danila, MD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.K. Owensby, PharmD, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham
| | - Shuo Yang
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; F. Xie, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; S. Yang, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M.I. Danila, MD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.K. Owensby, PharmD, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham
| | - Maria I Danila
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; F. Xie, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; S. Yang, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M.I. Danila, MD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.K. Owensby, PharmD, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham
| | - Justin K Owensby
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; F. Xie, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; S. Yang, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M.I. Danila, MD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.K. Owensby, PharmD, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham
| | - Lang Chen
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; F. Xie, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; S. Yang, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M.I. Danila, MD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.K. Owensby, PharmD, PhD, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham
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