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Valero M, Sánchez-Piedra C, Freire M, Colazo M, Busquets N, Meriño-Ibarra E, Rodríguez-Lozano C, Manrique S, Campos C, Sánchez-Alonso F, Castrejón I. Factors associated with discontinuation of biologics in patients with inflammatory arthritis in remission: data from the BIOBADASER registry. Arthritis Res Ther 2023; 25:86. [PMID: 37217997 PMCID: PMC10201751 DOI: 10.1186/s13075-023-03045-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The objectives of this study were to assess the discontinuation of biologic therapy in patients who achieve remission and identify predictors of discontinuation of biologics in patients with inflammatory arthritis in remission. METHODS An observational retrospective study from the BIOBADASER registry comprising adult patients diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) and receiving 1 or 2 biological disease-modifying drugs (bDMARDs) between October 1999 and April 2021. Patients were followed yearly after initiation of therapy or until discontinuation of treatment. Reasons for discontinuation were collected. Patients who discontinued bDMARDs because of remission as defined by the attending clinician were studied. Predictors of discontinuation were explored using multivariable regression models. RESULTS The study population comprised 3,366 patients taking 1 or 2 bDMARDs. Biologics were discontinued owing to remission by 80 patients (2.4%): 30 with RA (1.7%), 18 with AS (2.4%), and 32 with PsA (3.9%). The factors associated with a higher probability of discontinuation on remission were shorter disease duration (OR: 0.95; 95% CI: 0.91-0.99), no concomitant use of classic DMARDs (OR: 0.56; 95% CI: 0.34-0.92), and shorter usage of the previous bDMARD (before the decision to discontinue biological therapy) (OR: 1.01; 95% CI: 1.01-1.02); in contrast, smoking status (OR: 2.48; 95% CI: 1.21-5.08) was associated with a lower probability. In patients with RA, positive ACPA was associated with a lower probability of discontinuation (OR: 0.11; 95% CI: 0.02-0.53). CONCLUSIONS Discontinuation of bDMARDs in patients who achieve remission is uncommon in routine clinical care. Smoking and positive ACPA in RA patients were associated with a lower probability of treatment discontinuation because of clinical remission.
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Affiliation(s)
- Marta Valero
- Servicio de Reumatología, Hospital Universitario Ramón Y CajalInstituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Viejo Km: 9,100, 28034, Madrid, Spain.
| | - Carlos Sánchez-Piedra
- Health Technology Assessment Agency of Carlos III Institute of Health (ISCIII), Madrid, Spain
| | - Mercedes Freire
- Department of Rheumatology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - María Colazo
- Department of Rheumatology, Hospital Universitario de Burgos, Burgos, Spain
| | - Noemí Busquets
- Department of Rheumatology, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Erardo Meriño-Ibarra
- Department of Rheumatology, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Carlos Rodríguez-Lozano
- Department of Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Sara Manrique
- Department of Rheumatology, Hospital Universitario Regional de Málaga (Hospital Carlos Haya), Málaga, Spain
| | - Cristina Campos
- Department of Rheumatology, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Isabel Castrejón
- Department of Rheumatology, Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
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2
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Favero M, Ometto F, Belluzzi E, Cozzi G, Scagnellato L, Oliviero F, Ruggieri P, Doria A, Lorenzin M, Ramonda R. Fetuin-A: A Novel Biomarker of Bone Damage in Early Axial Spondyloarthritis. Results of an Interim Analysis of the SPACE Study. Int J Mol Sci 2023; 24:ijms24043203. [PMID: 36834615 PMCID: PMC9962253 DOI: 10.3390/ijms24043203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Our study aimed to evaluate the association between fetuin-A levels and the presence of radiographic sacroiliitis and syndesmophytes in patients with early axial spondyloarthritis (axSpA) and to identify potential predictors of radiographic damage in the sacroiliac joints (SIJs) after 24 months. Patients diagnosed with axSpA in the Italian cohort of the SpondyloArthritis-Caught-Early (SPACE) study were included. Physical examinations, laboratory tests (including fetuin-A), SIJ,+ and spinal X-rays and MRIs at T0 (diagnosis) and at T24 were considered. Radiographic damage in the SIJs was defined according to the modified New York criteria (mNY). Fifty-seven patients were included in this analysis (41.2% male, median (interquartile range), chronic back pain [CBP] duration of 12 (8-18) months). Fetuin-A levels were significantly lower in patients with radiographic sacroiliitis compared to those without at T0 (207.9 (181.7-215.9) vs. 239.9 (217.9-286.9), respectively, p < 0.001) and at T24 (207.6 (182.5-246.5) vs. 261.1 (210.2-286.6) µg/mL, p = 0.03). At T0, fetuin-A levels were significantly higher in non-smokers, in patients with heel enthesitis and in those with a family history of axSpA; fetuin-A levels at T24 were higher in females, in patients with higher ESR or CRP at T0 and in those with radiographic sacroiliitis at T0. Fetuin-A levels at T0 were independently negatively associated with the likelihood of radiographic sacroiliitis (OR = 0.9 per 10-unit increase (95% CI 0.8, 0.999), p = 0.048); but not with the presence of syndesmophytes. After adjustment for confounders, fetuin-A levels at T0 and T24 were also negatively associated with mNY at T0 (β -0.5, p < 0.001) and at T24 (β -0.3, p < 0.001), respectively. Among other variables at T0, fetuin-A levels did not achieve statistical significance in predicting mNY at T24. Fetuin-A levels were negatively associated with radiographic damage of the SIJs, but not of the spine, in early axSpA and after 2 years of follow-up. Our findings suggest that fetuin-A levels may serve as a biomarker to identify patients with a higher risk of developing severe disease and early structural damage.
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Affiliation(s)
- Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
- Internal Medicine I, Cà Foncello Hospital, 31100 Treviso, Italy
| | - Francesca Ometto
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Elisa Belluzzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, 35128 Padova, Italy
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Correspondence: (E.B.); (R.R.); Tel.: +390-498-213-348 (E.B.); +30-498-212-199 (R.R.)
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
- Correspondence: (E.B.); (R.R.); Tel.: +390-498-213-348 (E.B.); +30-498-212-199 (R.R.)
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Al Rayes H, Alazmi M, Alderaan K, Alghamdi M, Alghanim N, Alhazmi A, Alkhadhrawi N, Almohideb M, Alzahrani Z, Bedaiwi M, Halabi H, Attar S. Expert recommendations on early diagnosis and referral of axial spondyloarthritis in the Kingdom of Saudi Arabia. Clin Rheumatol 2022; 41:991-1002. [PMID: 34997382 DOI: 10.1007/s10067-021-06019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/11/2021] [Accepted: 12/04/2021] [Indexed: 01/13/2023]
Abstract
Axial spondyloarthritis is a chronic inflammatory disorder that primarily involves the axial skeleton (sacroiliac joints and spine), causing stiffness, severe pain and fatigue. In some patients, definitive structural damage of sacroiliac joints is visible on imaging and is known as radiographic axial spondyloarthritis. Some patients do not have a clear radiographic damage of the sacroiliac joints, and this subtype is known as non-radiographic axial spondyloarthritis. Early diagnosis is important for reducing the risk of irreversible structural damage and disability. Management of axial spondyloarthritis is challenging in Saudi Arabia because of inadequate disease knowledge and the unavailability of local guidelines. Therefore, this expert consensus is intended to provide recommendations, including the referral pathway, the definition of remission and the treat-to-target approach, to all healthcare professionals for the management of patients with axial spondyloarthritis. A Delphi technique of consensus was developed by involving an expert panel of 10 rheumatologists, 1 dermatologist and 1 general physician. The experts offered consensus-based recommendations based on a review of available scientific evidence and clinical experience for the referral, screening and management of patients with axial spondyloarthritis.
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Affiliation(s)
- Hanan Al Rayes
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, 21577, Saudi Arabia.
| | - Mansour Alazmi
- Department of Rheumatology, Prince Mohammed Medical City, Al Jouf, Saudi Arabia
| | - Khaled Alderaan
- Department of Rheumatology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mushabab Alghamdi
- Department of Rheumatology, University of Bisha, Bisha, Saudi Arabia
| | - Nayef Alghanim
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nadeer Alkhadhrawi
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammad Almohideb
- Department of Dermatology, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohamed Bedaiwi
- Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Costanzo A, Amerio P, Asero R, Chiricozzi A, Corazza M, Cristaudo A, Cusano F, Ferrucci SM, Nettis E, Patrizi A, Patruno C, Peris K, Picozza M, Stingeni L, Girolomoni G. Long-term management of moderate-to-severe adult atopic dermatitis: a consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Association of Italian Territorial and Hospital Allergists and Immunologists (AAIITO ), the Italian Association of Hospital Dermatologists (ADOI), the Italian Society of Allergological, Environmental and Occupational Dermatology (SIDAPA), and the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Ital J Dermatol Venerol 2021; 157:1-12. [PMID: 34929995 DOI: 10.23736/s2784-8671.21.07129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atopic dermatitis (AD) is a common chronic-relapsing inflammatory skin disease, burdened by various comorbidities. AD most commonly occurs in children but may persist or present in adulthood becoming a lifelong condition. Therefore, AD requires an effective long-term treatment improving disease signs and symptoms but also of patients' quality of life (QoL). However continuous long-term use of most traditional AD immunosuppressive treatments is not recommended for safety reasons or insufficient efficacy data. Despite the available guidelines, there is still need for knowledge of AD long-term treatment, taking into account new disease measures and recent treatment options. Five Italian scientific societies implemented a joint consensus procedure to define the most appropriate clinical practice for the long-term management of adult moderate-severe AD. Through a modified Delphi procedure, consensus was reached by overall 51 Italian dermatologists and allergists (The Italian AD Study Group) experienced in the management of adult AD on 14 statements covering three AD areas of interest, namely diagnosis, definition of disease severity and clinimetrics, and a treat-to-target approach. This paper reports and discusses the agreed statements, which define disease and patient impact measures, therapeutic approach, and a treatment decision algorithm to support clinicians in the long-term management of adult patients with moderate-to-severe AD in their daily clinical practice.
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Affiliation(s)
- Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Paolo Amerio
- Unit of Dermatology, Department of Medicine and Aging Science, G. D'Annunzio University, Chieti, Chieti-Pescara, Italy
| | - Riccardo Asero
- Department of Allergology, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | - Andrea Chiricozzi
- Unit of Dermatology, Department of Surgical and Medical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Unit of Dermatology, Department of Medicine and Translational Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonio Cristaudo
- Department of Dermatology, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Francesco Cusano
- Unit of Dermatology, San Pio Hospital - G. Rummo Hospital, Benevento, Italy
| | - Silvia M Ferrucci
- Section of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Annalisa Patrizi
- Dermatology of Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy - .,Unit of Dermatology, IRCCS S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Cataldo Patruno
- Department of Health Sciences, Magna Grecia University, Catanzaro, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Surgical and Medical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Unit of Dermatology, Department of Medicine and Translational Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Mario Picozza
- National Association of Atopic Dermatitis (ANDeA), Prato, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
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Portier E, Dougados M, Moltó A. Disease activity outcome measures are only available in half of the electronic medical files of patients with axial spondyloarthritis followed in an outpatient clinic: the results of an audit of a tertiary-care rheumatology department. Rheumatol Int 2021; 42:825-829. [PMID: 34821969 DOI: 10.1007/s00296-021-05055-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/13/2021] [Indexed: 12/29/2022]
Abstract
Current recommendations for management of patients with axial spondyloarthritis (axSpA) include regular collection of validated disease activity outcomes. This study aimed at evaluating the proportion of patients for whom validated outcome measures were available on their electronic medical reports (EMR), and the factors associated with the presence of such information on the EMR. We performed a cross-sectional monocentric observational study, including patients with an axSpA diagnosis who attended an outpatient visit between February, 2018 and February, 2019. Patients (demographics, disease characteristics, treatment) and physician characteristics (age, gender) and the disease activity outcome measures (BASDAI, CRP and ASDAS, and the items allowing to calculate them) were retrieved from the EMR. The proportion of patients in which disease activity outcome measures were available in the EMR was calculated, and the association between the presence of such outcomes and patients and physician's characteristics was evaluated. 320 EMR of axSpA patients seen in the outpatient clinic were examined. Among them, 131 (41%) and 123 (38.4%) had a BASDAI + CRP and an ASDAS reported, respectively, but at least one was available in 178 (55.6%) of the EMR. The most frequently reported disease activity items were duration of morning stiffness (n = 230, 72%) and CRP (n = 224, 70%). Only previous participation on a systematic holistic review was independently associated with a reported disease activity outcome. Thus, implementation of recommendations with regard to regularly collecting disease activity outcome measures is not optimal. The participation in educational programs including self-assessment educational programs might be a key to improve such implementation.
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Affiliation(s)
- Elodie Portier
- Rheumatology Department, Cochin Hospital, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,INSERM U-1153, CRESS, University of Paris, Paris, France
| | - Anna Moltó
- Rheumatology Department, Cochin Hospital, APHP, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,INSERM U-1153, CRESS, University of Paris, Paris, France
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The Association Between TNF Inhibitor Therapy Availability and Hospital Admission Rates for Patients with Ankylosing Spondylitis. A Longitudinal Population-Based Study. Rheumatol Ther 2021; 9:127-137. [PMID: 34762289 PMCID: PMC8814256 DOI: 10.1007/s40744-021-00393-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/26/2021] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND TNF inhibiting drugs (TNFi) provide symptomatic relief for patients with ankylosing spondylitis (AS), but uncertainty remains about long-term benefits. We compared hospital admissions, emergency department (ED) presentations, and direct health care costs before and after the availability of subsidized TNFi therapy for AS patients. METHODS State-specific dispensing and cost data for TNFi therapy for AS in Western Australia (WA) were obtained from Pharmaceutical Benefits Scheme (PBS) and expressed as the number of defined daily doses (DDD)/1000 population/day. Linked admission and ED data for 1783 AS patients followed for 14,257 person-years between 1990 and 2015 were extracted. Pre- and post-2005 admission rates/100,000 population were compared by rate ratio (RR). RESULTS TNFi uptake in WA reached a DDD/1000 population/day 0.45 at an annual cost of AU$17.7 million in 2020. Hospital admission rates remained unchanged (RR: 0.95, CI 0.71-1.27, p = 0.66) but increased slightly in female patients (RR 1.22; CI 0.91-1.64, p = 0.20). While there was no change in cardiovascular admissions (6.3 vs. 6.2%, p = 0.6) or ED visit rates since 2005, frequency for cancer (2.7 vs. 3.8%, p < 0.01), infection (1.1 vs. 1.7%, p < 0.01) and mental health (4.0 vs. 4.5%, p < 0.02) admissions increased. Associated direct health care costs (2020 values) averaged AU$14.7 million before and AU$ 24.7 million per year after 2005. CONCLUSIONS The introduction of subsidized TNFi therapy did not change all-cause hospital admission or ED visit rates for existing AS patients. Whether the significantly increased direct health care costs are offset by reductions in other health care costs remains to be determined.
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Nikiphorou E, Boonen A, Fautrel B, Richette P, Landewé R, van der Heijde D, Ramiro S. How do clinical and socioeconomic factors impact on work disability in early axial spondyloarthritis? Five-year data from the DESIR cohort. Rheumatology (Oxford) 2021; 61:2034-2042. [PMID: 34320627 PMCID: PMC9071517 DOI: 10.1093/rheumatology/keab607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/26/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives To investigate the impact of clinical and socioeconomic factors on work disability (WD) in early axial spondyloarthritis (axSpA). Methods Patients from the DESIR cohort with a clinical diagnosis of axSpA were studied over 5 years. Time to WD and potential baseline and time-varying predictors were explored, with a focus on socioeconomic (including ethnicity, education, job-type, marital/parental status) and clinical (including disease activity, function, mobility) factors. Univariable analyses, collinearity and interaction tests guided subsequent multivariable time-varying Cox survival analyses. Results From 704 patients eligible for this study, the estimated incidence of WD among those identified as at risk (n = 663, 94%), and across the five years of DESIR, was 0.05 (95% CI 0.03, 0.06) per 1000 person-days. Significant differences in baseline socioeconomic factors, including lower educational status and clinical measures, including worse disease activity, were seen in patients developing WD over follow-up, compared with those who never did. In the main multivariable model, educational status was no longer predictive of WD, whereas the AS disease activity score (ASDAS) and the BASFI were significantly and independently associated with a higher hazard of WD [HR (95%CI) 1.79 (1.27, 2.54) and 1.42 (1.22, 1.65), respectively]. Conclusion WD was an infrequent event in this early axSpA cohort. Nevertheless, clinical factors were among the strongest predictors of WD, over socioeconomic factors, with worse disease activity and function independently associated with a higher hazard of WD. Disease severity remains a strong predictor of adverse work outcome even in early disease, despite substantial advances in therapeutic strategies in axSpA.
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Affiliation(s)
- Elena Nikiphorou
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands.,Centre for Rheumatic diseases, King's College London, London, United Kingdom.,Department of Rheumatology, King's College Hospital, London, United Kingdom
| | - Annelies Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bruno Fautrel
- Dept of Rheumatology, Pitie Salpetriere Hospital, Pierre Louis Institute for Epidemiology and Public Health, Sorbonne University-Assistance Publique Hopitaux de Paris, INSERM UMRS 1136, PEPITES Teams, Paris, France
| | - Pascal Richette
- Department of Rheumatology, Hopital Lariboisière, Université de Paris, Paris, INSERM U1132, France
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands.,Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
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