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Dey M, Busby A, Isaac J, Pratt A, Ndosi M, Young A, Lempp H, Nikiphorou E. Personalised care packages for people with rheumatoid arthritis: a mixed-methods study. RMD Open 2024; 10:e003483. [PMID: 38191212 PMCID: PMC10806595 DOI: 10.1136/rmdopen-2023-003483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/24/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Disease management in rheumatoid arthritis (RA) requires holistic assessment. We aimed to design personalised care packages suitable for people with RA. METHODS This study was conducted using a mixed-methods approach and exploratory sequential design. Consensus workshops were held, involving people with RA and healthcare professionals (HCPs) treating them. Subsequently, an online survey sought views on future care packages for people with RA at relevant disease progression/stages, based on (1) results from previous quantitative data analyses (eg, socioeconomic/clinical factors), and (2) themes identified during workshops. RESULTS Two conceptual care pathways were identified: (1) around the time of RA diagnosis, an early opportunity to influence the disease course; (2) for individuals with established RA, emphasising the importance of 'the right MDT member at the right time'.Three care packages were suggested: (1) early care package (around RA diagnosis): introduction to MDT; (2) continuity of care package (established RA): primary/secondary providers; and (3) personalised holistic care package: integral to packages 1 and 2, implemented alongside allied health professionals.The survey received 41 responses; 82.9% agreed that people with RA need a consistent 'early care package' at diagnosis. 85.4% approved of additional care packages tailored to individuals' clinical, psychological and social needs when moving to different stages of their long-term disease. Fleiss' Kappa calculations demonstrated fair level of agreement among respondents. CONCLUSION Two care pathways, with three tailored care packages, were identified, with potential to improve management of people with RA. Future research will help to determine if such care packages can impact clinical (including patient-reported) outcomes.
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Affiliation(s)
- Mrinalini Dey
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King's College London School of Immunology & Microbial Sciences, London, UK
| | - Amanda Busby
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - John Isaac
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Arthur Pratt
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, College of Health Science and Society, University of the West of England, Bristol, UK
- Academic Rheumatology Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King's College London School of Immunology & Microbial Sciences, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King's College London School of Immunology & Microbial Sciences, London, UK
- Department of Rheumatology, King's College Hospital, London, UK
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Sepriano A, van Dijk B, Ramiro S, van der Helm-van Mil A, Combe B, van Schaardenburg D, de Wit M, Kent A, Mateus E, Landewé R. Distinction and prognosis of early arthritis phenotypes: an analysis in three European cohorts. RMD Open 2023; 9:e003611. [PMID: 37914180 PMCID: PMC10626756 DOI: 10.1136/rmdopen-2023-003611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The objective of this study is to evaluate whether there are differences in the long-term prognosis across various phenotypes of early arthritis (EA). METHODS Three EA cohorts (Reade, Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) and Early Arthritis Clinic (EAC)) were analysed. Clinical data were collected up to 24 years. Hands and feet radiographs were scored according to the Sharp van der Heijde (SvdH) method. Latent class analysis was applied to determine the EA phenotypes at baseline. Each class received a label reflecting its most prominent features. Prognostic outcomes included Health Assessment Questionnaire (HAQ), Short Form 36 (SF36) and SvdH score. The association between class membership and outcomes over time was tested in multivariable models. RESULTS In total, 390 (Reade), 798 (ESPOIR) and 3991 (EAC) patients were analysed separately. Two classes with symmetrical polyarthritis emerged; one of these labelled as autoimmune inflammatory polyarthritis (AIPA), had high likelihood of acute phase reactants (APR) elevation and autoantibody positivity, while the other (mild-inflammatory polyarthritis; MIPA) had not. A third class had oligoarthritis of upper limbs (OAUL) and could be subdivided into autoimmune OAUL and mild-inflammatory OAUL. A fifth class had oligoarthritis of lower limbs. The SvdH scores were worse in patients with APR/autoantibodies (AIPA) than in those without (MIPA). No clinically meaningful differences across classes in HAQ or SF36 over time were found. CONCLUSION Radiographic progression over time primarily occurs in EA patients with APR/autoantibodies. The absence of these markers, however, does not necessarily translate into better long-term function and quality of life. Clinicians should not only aim at preventing joint damage, but look beyond structural progression in order to further improve the lives of people with EA.
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Affiliation(s)
- Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | | | | | | | - Maarten de Wit
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Alison Kent
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Elsa Mateus
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Robert Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands
- Rheumatology, Zuyderland Medical Centre, Heerlen, Netherlands
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3
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Taylor PC, Laedermann C, Alten R, Feist E, Choy E, Haladyj E, De La Torre I, Richette P, Finckh A, Tanaka Y. A JAK Inhibitor for Treatment of Rheumatoid Arthritis: The Baricitinib Experience. J Clin Med 2023; 12:4527. [PMID: 37445562 DOI: 10.3390/jcm12134527] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Baricitinib, an oral selective Janus kinase (JAK)1/JAK2 inhibitor, is approved as monotherapy or in combination with methotrexate for treating adults with moderate-to-severe active rheumatoid arthritis (RA) and provides improvements in clinical signs, symptoms and patient-reported outcomes. Currently, baricitinib is approved for treating RA in more than 75 countries. In several pivotal Phase II and III RA trials (RA-BALANCE, RA-BEGIN, RA-BEAM, RA-BUILD, RA-BEACON, RA-BEYOND), up to seven years of baricitinib treatment was well tolerated and provided rapid and sustained efficacy, which was confirmed in real-world settings. Safety signals for another JAK inhibitor, tofacitinib, have emerged, as observed in the post-marketing Phase IIIb/IV trial Oral Rheumatoid Arthritis Trial (ORAL) Surveillance; safety signals were subsequently highlighted in a retrospective study of baricitinib and consequently new recommendations and warnings and precautions for all JAK inhibitors have been issued. Ongoing studies to further characterise and clarify the benefit:risk of JAK inhibitors include registries and controlled trials. This capstone review summarises clinical and real-world data outlining the benefit:risk profile of baricitinib, confirming that the improved disease activity and physical function of patients with RA treated with this JAK inhibitor observed in clinical trials is translated into effectiveness in clinical practice, with a low rate of discontinuations.
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Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | | | - Rieke Alten
- Internal Medicine II, Rheumatology, SCHLOSSPARK-KLINIK, University Medicine Berlin, 14059 Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology, Helios Clinic Vogelsang-Gommern, Cooperation Partner of the Otto-von-Guericke University Magdeburg, 39245 Magdeburg, Germany
| | - Ernest Choy
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4YS, UK
| | - Ewa Haladyj
- Eli Lilly and Company, Indianapolis, IN 46285, USA
| | | | - Pascal Richette
- Service de Rhumatologie, Hôpital Lariboisière, 75010 Paris, France
- Inserm, UMR-S 1132, Bioscar, Université de Paris, 75010 Paris, France
| | - Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu 807-0804, Japan
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4
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Gheita TA, Raafat HA, El-Bakry SA, Elsaman A, El-Saadany HM, Hammam N, El-Gazzar II, Samy N, Elsaid NY, Al-Adle SS, Tharwat S, Ibrahim AM, Fawzy SM, Eesa NN, Shereef RE, Ismail F, Elazeem MIA, Abdelaleem EA, El-Bahnasawy A, Selim ZI, Gamal NM, Nassr M, Nasef SI, Moshrif AH, Elwan S, Abdel-Fattah YH, Amer MA, Mosad D, Mohamed EF, El-Essawi DF, Taha H, Salem MN, Fawzy RM, Ibrahim ME, Khalifa A, Abaza NM, Abdalla AM, El-Najjar AR, Azab NA, Fathi HM, El-Hadidi K, El-Hadidi T. Rheumatoid arthritis study of the Egyptian College of Rheumatology (ECR): nationwide presentation and worldwide stance. Rheumatol Int 2023; 43:667-676. [PMID: 36617362 PMCID: PMC9995404 DOI: 10.1007/s00296-022-05258-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/04/2022] [Indexed: 01/09/2023]
Abstract
To depict the spectrum of rheumatoid arthritis (RA) in Egypt in relation to other universal studies to provide broad-based characteristics to this particular population. This work included 10,364 adult RA patients from 26 specialized Egyptian rheumatology centers representing 22 major cities all over the country. The demographic and clinical features as well as therapeutic data were assessed. The mean age of the patients was 44.8 ± 11.7 years, disease duration 6.4 ± 6 years, and age at onset 38.4 ± 11.6 years; 209 (2%) were juvenile-onset. They were 8750 females and 1614 males (F:M 5.4:1). 8% were diabetic and 11.5% hypertensive. Their disease activity score (DAS28) was 4.4 ± 1.4 and health assessment questionnaire (HAQ) 0.95 ± 0.64. The rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were positive in 73.7% and 66.7% respectively. Methotrexate was the most used treatment (78%) followed by hydroxychloroquine (73.7%) and steroids (71.3%). Biologic therapy was received by 11.6% with a significantly higher frequency by males vs females (15.7% vs 10.9%, p = 0.001). The least age at onset, F:M, RF and anti-CCP positivity were present in Upper Egypt (p < 0.0001), while the highest DAS28 was reported in Canal cities and Sinai (p < 0.0001). The HAQ was significantly increased in Upper Egypt with the least disability in Canal cities and Sinai (p = 0.001). Biologic therapy intake was higher in Lower Egypt followed by the Capital (p < 0.0001). The spectrum of RA phenotype in Egypt is variable across the country with an increasing shift in the F:M ratio. The age at onset was lower than in other countries.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Hala A Raafat
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samah A El-Bakry
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Ahmed Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hanan M El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Nora Y Elsaid
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzan S Al-Adle
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Amira M Ibrahim
- Rheumatology Department, Faculty of Medicine, Kafr El-Skeikh University, Kafr El-Shaikh, Egypt
| | - Samar M Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rawhya El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Enas A Abdelaleem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Amany El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Zahraa I Selim
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Nada M Gamal
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Maha Nassr
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Shereen Elwan
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Yousra H Abdel-Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Marwa A Amer
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Doaa Mosad
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Dina F El-Essawi
- Internal Medicine Department, Rheumatology Unit (NCRRT), Atomic Energy Authority (AEA), Cairo, Egypt
| | - Hanan Taha
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalyoubia, Egypt
| | - Maha E Ibrahim
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Asmaa Khalifa
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Noha A Azab
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Khaled El-Hadidi
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tahsin El-Hadidi
- Rheumatology Department, Military Academy, Agouza Rheumatology Center, Giza, Egypt
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Mou X, Jin Y, Jin D, Guan J, Zhang Q. Serum
HDAC4
level in rheumatoid arthritis: Longitudinal change during treatment and correlation with clinical outcomes. J Clin Lab Anal 2022; 36:e24594. [PMID: 35792020 PMCID: PMC9396184 DOI: 10.1002/jcla.24594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Histone deacetylase 4 (HDAC4) modulates immunity, inflammation, and osteoblast differentiation to engage in rheumatoid arthritis (RA) etiology. This study aimed to evaluate the HDAC4 longitudinal change and its relationship with clinical features and outcomes in RA patients. Methods Eighty‐three RA patients were enrolled. Their serum HDAC4 level was detected by ELISA at baseline (W0), week (W) 4, W12, and W24 after treatment. RA patients were divided into response or non‐response, low disease activity (LDA) or non‐LDA, remission or non‐remission patients according to their treatment outcomes at W24. Meanwhile, serum HDAC4 was detected by ELISA in 20 osteoarthritis patients and 20 healthy controls (HCs). Results HDAC4 level was reduced in RA patients compared with HCs (p < 0.001) and osteoarthritis patients (p = 0.009). HDAC4 was negatively related to some of the disease activity indexes such as C‐reactive protein (p = 0.003), tender joint count (p = 0.025), and disease activity score based on 28 joints (p = 0.013) in RA patients; it was also negatively correlated with TNF‐α (p = 0.003), IL‐6 (p = 0.022), and IL‐17A (p = 0.015). However, the HDAC4 level was not related to different treatment histories or current initiating treatment regimens (all p < 0.05). After treatment, HDAC4 was gradually elevated along with the time (p < 0.001). Interestingly, HDAC4 level at W12 (p = 0.041) and W24 (p = 0.012) was higher in response patients versus non‐response patients, and its level at W24 was higher in LDA patients versus non‐LDA patients (p = 0.019), and in remission patients versus non‐remission patients (p = 0.039). Conclusion HDAC4 gradually increases during treatment and its elevation estimates good treatment outcomes in RA patients.
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Affiliation(s)
- Xiaoyue Mou
- Department of RheumatologyFirst People's Hospital of TaizhouTaizhouChina
| | - Yi Jin
- Department of OphthalmologyFirst People's Hospital of TaizhouTaizhouChina
| | - Du Jin
- Department of RheumatologyFirst People's Hospital of TaizhouTaizhouChina
| | - Jintao Guan
- Department of RheumatologyFirst People's Hospital of TaizhouTaizhouChina
| | - Qian Zhang
- Department of RheumatologyFirst People's Hospital of TaizhouTaizhouChina
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6
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Hammer HB, Caporali R. Controversies in rheumatology: Ultrasound for monitoring of RA - do we need it? Rheumatology (Oxford) 2022; 61:4245-4251. [PMID: 35394009 DOI: 10.1093/rheumatology/keac228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/10/2022] [Accepted: 04/03/2022] [Indexed: 11/14/2022] Open
Abstract
Clinical joint examination is the cornerstone for evaluation of patients with rheumatoid arthritis (RA). However, since large discrepancies have been shown even between experienced rheumatologists in evaluation of joint inflammation, and tender joints may have limited value in reflecting inflammation, ultrasound has in the last decennials been introduced in the clinical assessments of RA patients. Ultrasound has high accordance with other imaging modalities and enables detection of clinically difficult pathologies and contributes to assessments of joints difficult to evaluate clinically. However, there is no general agreement on the optimal use of ultrasound in rheumatology and the prevalence of machines as well as the level of experience is highly different across the countries. In addition, standardized use of ultrasound in treat-to-target follow-up of RA patients was found not to have any added value. Thus, how to use ultrasound in monitoring of RA patients is open for debate. The present article will discuss the pros and cons for using ultrasound in the clinical setting.
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Affiliation(s)
- Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of medicine, University of Oslo, Norway
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Rheumatology and Medical Sciences, ASST Pini-CTO, Milan, Italy
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