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Oudkerk SF, Mohamed Hoesein FAA, Öner FC, Verlaan JJ, de Jong PA, Kuperus JS, Cho M, McDonald ML, Lynch DA, Silverman EK, Crapo JD, Make BJ, Lowe KE, Regan EA. Diffuse Idiopathic Skeletal Hyperostosis in Smokers and Restrictive Spirometry Pattern: An Analysis of the COPDGene Cohort. J Rheumatol 2019; 47:531-538. [PMID: 31043539 DOI: 10.3899/jrheum.181357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by bony proliferation at sites of tendinous and ligamentous insertions in the spine. Spinal mobility is reduced in DISH and may affect movement in the thorax, potentially leading to restrictive pulmonary function. This study investigated whether DISH is associated with restrictive spirometric pattern (RSP) in former and current smokers. METHODS Participants (n = 1784) with complete postbronchodilator spirometry who did not meet spirometric criteria for chronic obstructive pulmonary disease (COPD) at time of enrollment in the COPDGene study were included in this study. Subjects were classified as RSP if they had forced expiratory volume in 1 s(FEV1) to forced vital capacity (FVC) ratio > 0.7 with an FVC < 80%. Computed tomography (CT) scans were scored for the presence of DISH in accordance with the Resnick criteria. Chest CT measures of interstitial and alveolar lung disease, clinical symptoms, health surveys, and 6-min walking distance were recorded. Uni- and multivariable analyses were performed to test the association of DISH with RSP. RESULTS DISH was present in 236 subjects (13.2%). RSP was twice as common in participants with DISH (n = 90/236, 38.1%) compared to those without DISH (n = 301/1548, 19.4%; p < 0.001). In multivariable analysis, DISH was significantly associated with RSP (OR 1.78; 95% CI 1.22-2.60; p = 0.003) after adjusting for potential confounders. The RSP group with and without DISH had significantly worse spirometry, dyspnea, St. George's Respiratory Questionnaire score, BODE index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity), and Medical Outcomes Study Short Form-36 questionnaire score. CONCLUSION In heavy smokers with an FEV1/FVC ratio > 0.70, DISH is associated with RSP after adjustment for intrinsic and extrinsic causes of restrictive lung function. (Clinical trial registration number: NCT00608764.).
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Affiliation(s)
- Sytse F Oudkerk
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Firdaus A A Mohamed Hoesein
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - F Cumhur Öner
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Jorrit-Jan Verlaan
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Pim A de Jong
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK. .,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology.
| | - Jonneke S Kuperus
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Michael Cho
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Merry-Lynn McDonald
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - David A Lynch
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Edwin K Silverman
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - James D Crapo
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Barry J Make
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Katherine E Lowe
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Elizabeth A Regan
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
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