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ŞAŞAK KUZGUN G, MURAT S, ÖZKÖK S, KASAPOGLU E. Sulfasalazine related nephrolithiasis in patients with rheumatoid arthritis and ankylosing spondylitis. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1058021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Sulfasalazine (SSZ) is an anti-inflammatory and immunomodulatory drug used to treat many inflammatory diseases. Bacteria in the gut metabolize SSZ to active 5-aminosalicylic acid and inactive sulfapyridine. Sulfapyridine can crystallize in the kidney. We aimed to investigate the frequency of nephrolithiasis in patients who were diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and who received SSZ treatment retrospectively.
Material and Methods We retrospectively analyzed the files of AS and RA patients in the rheumatology outpatient clinic between 2009 and 2018. We identified patients who underwent kidney ultrasonography at least six months after initiation of SSZ. One hundred six patients and 50 healthy adults were included in the study.
Results Only eight patients (6 AS, 2 RA) had nephrolithiasis on ultrasonography, but none in the control group (p=0.046). In logistic regression analysis, no correlation was found between gender, age, vitamin D, parathyroid hormone, and urinary calcium excretion with SSZ use (p>0.05).
Conclusion Although, it is noteworthy that these patients are prone to stone formation for various reasons. Therefore, paying attention to the patient’s hydration while using these drugs may prevent such side effects.
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Affiliation(s)
| | - Sadiye MURAT
- Istanbul Prof Dr Suleyman Yalcin City Hospital, Department of Physical Therapy and Rehabilitation
| | - Serçin ÖZKÖK
- Acibadem International Hospital, Department of Radiology
| | - Esen KASAPOGLU
- Istanbul Medeniyet University, Department of Rheumatology
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Dimke H, Winther-Jensen M, Allin KH, Lund L, Jess T. Risk of Urolithiasis in Patients With Inflammatory Bowel Disease: A Nationwide Danish Cohort Study 1977-2018. Clin Gastroenterol Hepatol 2021; 19:2532-2540.e2. [PMID: 33007511 DOI: 10.1016/j.cgh.2020.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease (IBD) are suggested to be at increased risk of urolithiasis, but the magnitude of risk and the impact of medical and surgical treatment on this risk remain unknown. We therefore aimed to determine overall and treatment-related risk of urolithiasis in patients with IBD in a nationwide population-based cohort study. METHODS Using national registers, we identified all patients with IBD and all cases of urolithiasis in Denmark during 1977-2018. We obtained information on all IBD medications and surgical procedures during 1995-2018. IBD cases were matched 1:10 on age and sex to non-IBD individuals. RESULTS In total, 2,549 (3%) of 75,236 IBD patients and 11,258 (2%) of 767,403 non-IBD individuals developed urolithiasis, resulting in a 2-fold increased risk of urolithiasis (HR, 2.27; 95% CI, 2.17-2.38) in patients with IBD. The patients were also at increased risk of repetitive urolithiasis events (RR, 1.09; 95% CI: 1.04-1.15) and had increased risk of urolithiasis prior to IBD diagnosis (OR, 1.42; 95% CI: 1.34-1.50). After IBD diagnosis, risk of urolithiasis was associated with anti-TNF therapy and surgery. CONCLUSION Patients with IBD had a 2-fold increased risk of urolithiasis after IBD diagnosis and a 42% increased risk prior to IBD diagnosis. Risk was increased in anti-TNF exposed patients, and after surgery, suggesting that IBD severity per se and surgery, with altered intestinal absorption, increase risk of urolithiasis. Since stone formation is associated with adverse outcomes including sepsis, subpopulations of IBD patients, especially those undergoing strong immunosuppression might benefit from additional urolithiasis screening.
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Affiliation(s)
- Henrik Dimke
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Nephrology, Odense University Hospital, Odense, Denmark.
| | - Matilde Winther-Jensen
- Section for Clinical Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kristine Højgaard Allin
- Section for Clinical Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Lund
- Research Unit for Urology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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3
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Ward MM, Alehashemi S. Risks of solid cancers in elderly persons with osteoarthritis or ankylosing spondylitis. Rheumatology (Oxford) 2021; 59:3817-3825. [PMID: 32442295 DOI: 10.1093/rheumatology/keaa166] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/13/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Patients with osteoarthritis and ankylosing spondylitis have lower cancer-related mortality than the general population. We examined risks of solid cancers at 16 sites in elderly patients with knee or hip osteoarthritis (KHOA) or ankylosing spondylitis. METHODS In this population-based retrospective cohort study, we used US Medicare data from 1999 to 2010 to identify cohorts of persons with KHOA or ankylosing spondylitis, and a general population group without either condition, who were followed through 2015. We compared cancer incidence among groups, adjusted for age, sex, race, socioeconomic characteristics, geographic region, smoking and comorbidities. RESULTS We studied 2 701 782 beneficiaries with KHOA, 13 044 beneficiaries with ankylosing spondylitis, and 10 859 304 beneficiaries in the general population group. Beneficiaries with KHOA had lower risks of cancer of the oropharynx, oesophagus, stomach, colon/rectum, hepatobiliary tract, pancreas, larynx, lung, and ovary than the general population. However, beneficiaries with KHOA had higher risks of melanoma, renal cell cancer, and cancer of the bladder, breast, uterus and prostate. Associations were similar in ankylosing spondylitis, with lower risks of cancer of the oesophagus, stomach, and lung, and higher risks of melanoma, renal cell cancer, and cancer of the renal pelvis/ureter, bladder, breast, and prostate. CONCLUSION Lower risks of highly prevalent cancers, including colorectal and lung cancer, may explain lower cancer-related mortality in patients with KHOA or ankylosing spondylitis. Similarities in cancer risks between KHOA and AS implicate a common risk factor, possibly chronic NSAID use.
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Affiliation(s)
- Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sara Alehashemi
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Xiao M, Lv Q, Zhang Y, Tu L, Yang M, Lin Z, Liao Z, Jiang Y, Zheng X, Li X, Wei Q, Cao S, Gu J. Spondyloarthritis Patients Suffer Increased Risk of Renal Complications Compared With General Population: A Retrospective Observational Study. Front Pharmacol 2019; 10:1073. [PMID: 31620002 PMCID: PMC6759995 DOI: 10.3389/fphar.2019.01073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/22/2019] [Indexed: 01/01/2023] Open
Abstract
The objective of this study was to identify the prevalence and risk factors of renal complications of spondyloarthritis (SpA) patients, and to assess increased risks compared to general people. We conducted a retrospective study enrolled with consecutive SpA patients from an inpatient department and age, sex-matched general population (GP). The renal disorders investigated in this study contained decreased estimated glomerular filtration rate (eGFR), hematuria, proteinuria and nephrolithiasis. A total of 350 admitted SpA patients with complete medical records and 323 age and sex-matched GP were enrolled. Most SpA patients were male (n = 283, 80.9%) and the mean age was 31.61 ± 10.73 years old. Among 350 SpA patients, 29 (8.8%) suffered from hematuria, six (1.8%) suffered from proteinuria, one (0.3%) had decreased eGFR, and 27 (13.0%) presented with nephrolithiasis. The relative risk (RR) of nephrolithiasis in SpA compared to the GP was 2.24 (95% CI, 1.00-4.98), and the RR of renal insufficiency was 2.04 (95% CI, 1.11-3.77). In a univariate analysis, nephrolithiasis was significantly associated with age, age of onset, smoking, extra-articular manifestation and a bamboo spine. Renal insufficiency was significantly associated with age, peripheral manifestation, serum albumin, C-reactive protein and erythrocyte sedimentation rate. In a multivariable analysis, only extra-articular manifestation (OR = 8.43, 95% CI, 1.65-43.06, p = 0.010) and bamboo spine (OR = 3.47, 95% CI, 1.01-12.06, p = 0.049) remained significantly associated with nephrolithiasis. However, no variable was recognized as an independent risk factor for renal insufficiency. Renal complications are more common in SpA patients, with more than two-fold increased risk compared with GP. Extra-articular manifestation and bamboo spine are independent risk factors of renal disease in SpA patients.
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Affiliation(s)
- Min Xiao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Lv
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanli Zhang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liudan Tu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingcan Yang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhiming Lin
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zetao Liao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yutong Jiang
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuqi Zheng
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Li
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuangyan Cao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Aune D, Mahamat-Saleh Y, Norat T, Riboli E. Body fatness, diabetes, physical activity and risk of kidney stones: a systematic review and meta-analysis of cohort studies. Eur J Epidemiol 2018; 33:1033-1047. [PMID: 30066054 PMCID: PMC6208979 DOI: 10.1007/s10654-018-0426-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/17/2018] [Indexed: 12/15/2022]
Abstract
We conducted a systematic review and meta-analysis to clarify the association between adiposity, diabetes, and physical activity and the risk of kidney stones. PubMed and Embase were searched up to April 22nd 2018 for relevant studies. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. Thirteen cohort studies were included. The summary relative risk was 1.21 (95% CI 1.12-1.30, I2 = 76%, n = 8) per 5 unit increment in BMI, 1.16 (95% CI 1.12-1.19, I2 = 0%, n = 5) per 10 cm increase in waist circumference, 1.06 (95% CI 1.04-1.08, I2 = 67%, n = 3) per 5 kg increase in weight and 1.12 (95% CI 1.06-1.18, I2 = 86%, n = 3) per 5 kg of weight gain. The summary RR was 1.16 (95% CI 1.03-1.31, I2 = 51%, n = 10) for participants with diabetes compared to participants without diabetes, and 0.93 (95% CI 0.78-1.10, I2 = 80%, n = 4) for high vs. low physical activity. These results suggest a positive association between adiposity and diabetes and the risk of kidney stones, but no association with physical activity.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
- Department of Nutrition, Bjørknes University College, Oslo, Norway.
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - Yahya Mahamat-Saleh
- INSERM (French National Institute for Health and Medical Research), CESP, Gustave Roussy, Health Across Generations Team, Villejuif, France
| | - Teresa Norat
- Department of Nutrition, Bjørknes University College, Oslo, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
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Korkmaz C, Cansu DU. Comment on: Managing morbidity and treatment-related toxicity in patients with ankylosing spondylitis. Rheumatology (Oxford) 2018; 57:1871-1872. [DOI: 10.1093/rheumatology/key239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cengiz Korkmaz
- Department of Internal Medicine, Division of Rheumatology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Döndü U Cansu
- Department of Internal Medicine, Division of Rheumatology, Eskisehir Osmangazi University, Eskisehir, Turkey
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Nephrolithiasis in ankylosing spondylitis and its relationship with disease assessment scales. North Clin Istanb 2018; 6:254-259. [PMID: 31650112 PMCID: PMC6790921 DOI: 10.14744/nci.2018.58219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/12/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE: The aim of this study was to investigate the frequency of renal calculi in patients with ankylosing spondylitis (AS) and to determine its relationship with disease assessment variables. METHODS: The study was designed retrospectively, and it included a cohort of 320 patients with AS diagnosed using the Modified New York Criteria. A total of 119 patients who underwent renal ultrasonography (USG), in who the erythrocyte sedimentation rate, C-reactive protein, blood calcium, phosphorus, Vitamin D, parathormone, and urinary calcium excretion were measured, and who also had lateral cervical and lumbar radiography in the same time period were extracted from the cohort. All patients’ demographic characteristics and the results of blood and urine tests were recorded. The Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Mobility Index (BASMI), and Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) were evaluated in all patients. RESULTS: Thirteen of the 119 patients had renal calculi confirmed by USG data. The frequency of nephrolithiasis detected by USG was 10.9% in patients with AS. The disease lasted significantly longer in patients with renal calculi ([nephrolithiasis (+): 18.39±8.72 years; nephrolithiasis (−): 12.02±8.43 years, p=0.01]). The BASMI total score was significantly higher in the group of patients with renal calculi. There was not any significant difference in terms of blood samples, HLA-B27, BASDAI, BASFI, and mSASSS between groups. CONCLUSION: The frequency of renal stones is increased in patients with AS compared to healthy population. Especially patients who had AS for a long time and higher BASMI values are more susceptible to renal calculi. It is important to point out that the results of this type of studies would be more reliable if the study is conducted on large patient groups and population-based prevalence.
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Couderc M, Pereira B, Molto A, Tiple A, Soubrier M, Dougados M. The Prevalence of Renal Impairment in Patients with Spondyloarthritis: Results from the International ASAS-COMOSPA Study. J Rheumatol 2018; 45:795-801. [PMID: 29657148 DOI: 10.3899/jrheum.170133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the prevalence and association of renal dysfunction in patients with spondyloarthritis (SpA). METHODS The ASAS-COMOSPA (Assessment of Spondyloarthritis international Society-COMOrbidities in SPondyloArthritis) was an international study (22 participating countries from 4 continents) investigating comorbidities in SpA. Renal function was assessed based on estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease equation. SpA characteristics and risk factors for renal impairment were collected. Nonsteroidal antiinflammatory drug (NSAID) use was assessed based on current intake (last 3 mos). RESULTS Of the 3984 patients recruited, 2098 (52.6%) were analyzed after excluding outliers and patients with no available eGFR measurement [male sex: 63.5%; age: 45.3 yrs; disease duration: 8.6 years; HLA-B27+: 73.1%; Bath Ankylosing Spondylitis Activity Index (BASDAI): 3.6/10]. Overall, 153 patients (5.2%, mean age: 53.6 yrs) exhibited an eGFR < 60 ml/min/1.73 m2. In univariate analysis, renal impairment was associated with age (p < 0.001), HLA-B27 positivity (p = 0.003), several cardiovascular (CV) risk factors (history of hypertension, p < 0.001; systolic blood pressure, p = 0.009; diabetes, p = 0.005; and Framingham risk score, p < 0.001), disease activity scores [BASDAI, p = 0.001; Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), p < 0.001], functional variables (Bath Ankylosing Spondylitis Functional Index, p < 0.001), inflammatory biomarkers (erythrocyte and CRP, both p < 0.001), and NSAID intake since onset of disease (percentage of days, p = 0.008). However, there was no association with disease duration, disease severity, or ASAS-NSAID score. In multivariate analysis, age (45-59 yrs: OR 1.9, > 60 yrs: OR 6.2), HLA-B27 positivity (OR 0.51), and CRP (OR 1.3) remained significantly associated with eGFR < 60 ml/min/1.73 m2. CONCLUSION Renal impairment was associated with age, HLA-B27 positivity, and inflammation, though not with CV risk factors, disease severity, or NSAID intake in patients with SpA.
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Affiliation(s)
- Marion Couderc
- From the Department of Rheumatology, and Biostatistics unit (DRCI), and Department of Nephrology, Gabriel Montpied University Hospital, Clermont-Ferrand; Department of Rheumatology, Paris Descartes University, and Hôpital Cochin; AP-HP; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
- M. Couderc, MD, Department of Rheumatology, Gabriel Montpied University Hospital; B. Pereira, PhD, Biostatistics unit (DRCI), Gabriel Montpied University Hospital; A. Molto, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; A. Tiple, MD, Department of Nephrology, Gabriel Montpied University Hospital; M. Soubrier, MD, PhD, Department of Rheumatology, Gabriel Montpied University Hospital; M. Dougados, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité.
| | - Bruno Pereira
- From the Department of Rheumatology, and Biostatistics unit (DRCI), and Department of Nephrology, Gabriel Montpied University Hospital, Clermont-Ferrand; Department of Rheumatology, Paris Descartes University, and Hôpital Cochin; AP-HP; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
- M. Couderc, MD, Department of Rheumatology, Gabriel Montpied University Hospital; B. Pereira, PhD, Biostatistics unit (DRCI), Gabriel Montpied University Hospital; A. Molto, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; A. Tiple, MD, Department of Nephrology, Gabriel Montpied University Hospital; M. Soubrier, MD, PhD, Department of Rheumatology, Gabriel Montpied University Hospital; M. Dougados, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité
| | - Anna Molto
- From the Department of Rheumatology, and Biostatistics unit (DRCI), and Department of Nephrology, Gabriel Montpied University Hospital, Clermont-Ferrand; Department of Rheumatology, Paris Descartes University, and Hôpital Cochin; AP-HP; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
- M. Couderc, MD, Department of Rheumatology, Gabriel Montpied University Hospital; B. Pereira, PhD, Biostatistics unit (DRCI), Gabriel Montpied University Hospital; A. Molto, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; A. Tiple, MD, Department of Nephrology, Gabriel Montpied University Hospital; M. Soubrier, MD, PhD, Department of Rheumatology, Gabriel Montpied University Hospital; M. Dougados, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité
| | - Aurélien Tiple
- From the Department of Rheumatology, and Biostatistics unit (DRCI), and Department of Nephrology, Gabriel Montpied University Hospital, Clermont-Ferrand; Department of Rheumatology, Paris Descartes University, and Hôpital Cochin; AP-HP; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
- M. Couderc, MD, Department of Rheumatology, Gabriel Montpied University Hospital; B. Pereira, PhD, Biostatistics unit (DRCI), Gabriel Montpied University Hospital; A. Molto, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; A. Tiple, MD, Department of Nephrology, Gabriel Montpied University Hospital; M. Soubrier, MD, PhD, Department of Rheumatology, Gabriel Montpied University Hospital; M. Dougados, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité
| | - Martin Soubrier
- From the Department of Rheumatology, and Biostatistics unit (DRCI), and Department of Nephrology, Gabriel Montpied University Hospital, Clermont-Ferrand; Department of Rheumatology, Paris Descartes University, and Hôpital Cochin; AP-HP; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
- M. Couderc, MD, Department of Rheumatology, Gabriel Montpied University Hospital; B. Pereira, PhD, Biostatistics unit (DRCI), Gabriel Montpied University Hospital; A. Molto, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; A. Tiple, MD, Department of Nephrology, Gabriel Montpied University Hospital; M. Soubrier, MD, PhD, Department of Rheumatology, Gabriel Montpied University Hospital; M. Dougados, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité
| | - Maxime Dougados
- From the Department of Rheumatology, and Biostatistics unit (DRCI), and Department of Nephrology, Gabriel Montpied University Hospital, Clermont-Ferrand; Department of Rheumatology, Paris Descartes University, and Hôpital Cochin; AP-HP; INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
- M. Couderc, MD, Department of Rheumatology, Gabriel Montpied University Hospital; B. Pereira, PhD, Biostatistics unit (DRCI), Gabriel Montpied University Hospital; A. Molto, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; A. Tiple, MD, Department of Nephrology, Gabriel Montpied University Hospital; M. Soubrier, MD, PhD, Department of Rheumatology, Gabriel Montpied University Hospital; M. Dougados, MD, PhD, Department of Rheumatology, Paris Descartes University, and Hôpital Cochin, and AP-HP, and INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité
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Mahmood F, Helliwell P. Ankylosing Spondylitis: A Review. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10314487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Ankylosing spondylitis is a chronic autoimmune inflammatory condition belonging to the spondyloarthropathy category of rheumatic diseases. It typically affects the axial skeleton but may also present with peripheral arthritis and extra-articular features. Ankylosing spondylitis tends to occur in patients under the age of 45 years, has a higher incidence in males, and can lead to disability and reduced quality of life if not adequately treated. Management consists of a multidisciplinary team approach. Although traditional disease modifying anti-rheumatic drugs are less effective for the axial component of this disease, biologic therapies do seem effective. In severe cases, surgery may be warranted.
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Landgren AJ, Jacobsson LTH, Lindström U, Sandström TZS, Drivelegka P, Björkman L, Fjellstedt E, Dehlin M. Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study. Arthritis Res Ther 2017; 19:173. [PMID: 28738835 PMCID: PMC5525359 DOI: 10.1186/s13075-017-1376-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nephrolithiasis (NL) is known to be associated with gout, although there are few comparative studies on risk and risk factors for NL in gout compared to population cohorts. In this cohort study we investigated: (1) overall incidence of NL in gout (cases) and general population controls; (2) risk and risk factors (common comorbidities and medications) for first-time NL in cases and controls separately. METHODS Cases (n = 29,968) and age-matched and sex-matched controls (n = 138,678) were identified from the regional healthcare database in western Sweden (VEGA). The analyzed risk factors (comorbidities and current medication use) for first-time NL, and socioeconomic factors were retrieved from VEGA and other national Swedish registers. For cases, follow up began on 1 January 2006 or on the first diagnosis of gout if this occurred later, and for controls on their index patient's first diagnosis of gout. Follow up ended on death, emigration or 31 December 2012. Incidence rates (IR) per 1000 person-years and hazard ratios (HR) were calculated. The incidence calculations were performed for cases (regardless of prior NL) and their controls. HRs with first occurrence of NL as outcome were calculated only in those without previous NL. RESULTS In cases there were 678 NL events (IR: 6.16 events per 1000 person-years (95% CI: 5.70-6.64) and in controls 2125 NL events (IR 3.85 events per 1000 person-years (95% CI: 3.69-4.02), resulting in an age-sex-adjusted incidence rate ratio of 1.60 (95% CI:1.47-1.74). Point estimates for predictive factors were similar in cases and controls, except for a significant interaction for losartan which increased the risk of NL only in controls (HR = 1.49 (95% CI: 1.03-2.14). Loop diuretics significantly decreased the risk of NL by 30-34% in both cases and controls. Further significant predictors of NL in gout cases were male sex, diabetes and obesity and in controls male sex and kidney disease. CONCLUSIONS The risk (age and sex adjusted) of NL was increased by 60% in cases compared to controls. None of the commonly used medications increased the risk of NL in gout patients.
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Affiliation(s)
- A J Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden.
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - T Z S Sandström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - P Drivelegka
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - L Björkman
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - E Fjellstedt
- Department of Nephrology and Transplantation, SUS University Hospital, Malmö, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
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Andreasen RA, Kristensen LE, Ellingsen T, Christensen R, Baraliakos X, Wied J, Aalykke C, Ulstrup T, Schiøttz-Christensen B, Horn HC, Emamifar A, Duerlund B, Fischer L, Hansen IMJ. Clinical characteristics of importance to outcome in patients with axial spondyloarthritis: protocol for a prospective descriptive and exploratory cohort study. BMJ Open 2017; 7:e015536. [PMID: 28698330 PMCID: PMC5734256 DOI: 10.1136/bmjopen-2016-015536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Spondyloarthritis (SpA) is a heterogeneous spectrum of rheumatic diseases with either predominantly axial inflammatory symptoms of the spine and sacroiliac joints or predominantly peripheral arthritis. The two main entities of axial SpA (axSpA) are ankylosing spondylitis or non-radiographic axSpA (nr-axSpA). Tumour necrosis factor-α inhibitors have revolutionised the treatment of patients with axSpA who failed to respond to non-steroidal anti-inflammatory drugs and physical therapy. Chronic pain is common in patients with SpA and may still persist despite the lack of signs of inflammation. This has led researchers to hypothesise that central pain sensitisation may play a role in the generation of chronic pain in SpA. The painDETECT Questionnaire (PDQ) is a screening tool developed to detect neuropathic pain components. The primary objective is to explore the prognostic value of the PDQ regarding treatment response in patients with axSpA 3 months after initiating a biological agent. Secondary aim is to evaluate the impact of extra-articular manifestations, comorbidities and patient-reported outcomes and elucidate if these factors influence treatment response. METHOD AND ANALYSIS We will include 60 participants (≥18 years of age) diagnosed with axSpA independent of main entity, who initiate or switch treatment of a biologic. Data will be collected at baseline and at endpoint following Danish clinical practice (≥3 months) of treatment with biologics. We will explore whether the PDQ and other phenotypical patient characteristics are prognostically important for response to biological therapy according to established response criteria like 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (50%) and Ankylosing Spondylitis Disease Activity Score. ETHICS AND DISSEMINATION The study is approved by the Region of Southern Denmark's Ethics committee (S-20160094) and has been designed in cooperation with patient representatives. The study is registered at clinicaltrials.gov (NCT02948608, pre-results). Dissemination will occur through publication(s) in international peer-reviewed journal(s).
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Affiliation(s)
- Rikke Asmussen Andreasen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg, Denmark
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lars Erik Kristensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Torkell Ellingsen
- Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Jimmi Wied
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Claus Aalykke
- Department of Medicine, Section of Gastroenterology, Odense University Hospital, Svendborg, Denmark
| | - Thomas Ulstrup
- Department of Medicine, Section of Gastroenterology, Odense University Hospital, Svendborg, Denmark
| | - Berit Schiøttz-Christensen
- Department of Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | | | - Amir Emamifar
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg, Denmark
| | - Bent Duerlund
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg, Denmark
| | - Lars Fischer
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg, Denmark
| | - Inger Marie Jensen Hansen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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The Risk of Nephrolithiasis Among Patients With Ankylosing Spondylitis: a Population-Based Cohort Study. Arch Rheumatol 2016; 31:346-352. [PMID: 30375555 DOI: 10.5606/archrheumatol.2016.5938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/24/2016] [Indexed: 12/17/2022] Open
Abstract
Objectives This study aims to investigate the correlation of ankylosing spondylitis (AS) with nephrolithiasis by performing a nationwide population- based cohort study. Patients and methods The data used in this retrospective cohort study were collected from the Taiwan National Health Insurance Research database. The study included a total of 3,334 AS patients (1,914 males, 1,420 females; mean age 44.51±16.83 years; range 22 to 79 years) and 13,336 non-AS patients (7,656 males, 5,680 females; mean age 44.27±17.01 years; range 21 to 78 years) who had been followed-up on an average of 6.78 years and 6.75 years, respectively, between January 2000 and December 2008. Results The percentage of newly diagnosed nephrolithiasis was 4.8% in all study subjects. However, the percentages of newly diagnosed nephrolithiasis were 5.76% and 4.58% in the AS and non-AS cohorts, respectively. After adjusting the patients' sex, age, urbanization level, and comorbidities, the hazard ratio obtained from our multivariable Cox model was 1.19. Conclusion Our study findings indicate that patients with AS are more likely to develop nephrolithiasis than non-AS patients.
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Jakobsen AK, Jacobsson LTH, Patschan O, Hopfgarten T, Askling J, Kristensen LE. Surgical interventions for nephrolithiasis in ankylosing spondylitis and the general population. Scand J Urol 2015; 49:486-491. [PMID: 26389795 DOI: 10.3109/21681805.2015.1089523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to estimate rates and type of definitive surgical interventions for nephrolithiasis in Swedish patients with ankylosing spondylitis (AS) compared to the general population. MATERIALS AND METHODS This national prospective cohort study linked data from Swedish population and healthcare registries. Incidence rates and interventions for nephrolithiasis during follow-up in patients with AS were compared to general population comparator (GPC) subjects. RESULTS In total, 8572 AS patients were followed for 49,959 person-years and 39,639 matched GPCs were followed for 225,221 person-years. Mean age at study entry was 46 years [interquartile range (IQR) 36-56 years] and 65% were male. In AS patients with a diagnosis of nephrolithiasis during the study period, 29% (72/250) underwent similar intervention for nephrolithiasis compared to 24% (114/466) GPCs (p = 0.21). The incidence rate ratio (RR) in overall AS patients was 2.9 [95% confidence interval (CI) 2.1-3.8] during a median follow-up of 6.2 years (IQR 3.2-8.6 years). With prior diagnosis of nephrolithiasis, the RR for AS patients compared to GPCs was 3.7 (95% CI 1.8-7.7); without prior nephrolithiasis the RR was 2.1 (95% CI 1.5-3.0). Increasing age [odds ratio (OR) 1.02, 95% CI 1.01-1.03], prior nephrolithiasis diagnosis (OR 3.3, 95% CI 1.97-5.62) and atherosclerotic cardiac disease (OR 2.0, 95% CI 1.03-3.91) were identified as predictors of intervention for nephrolithiasis. CONCLUSIONS Patients with AS have an almost three-fold increased risk of surgical intervention for kidney stones, with similar management, compared to the general population.
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Affiliation(s)
- Ane Krag Jakobsen
- a Department of Urology, Skåne University Hospital, Lund University , Malmö, Sweden
| | - L T H Jacobsson
- b Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg , Gothenburg, Sweden.,c Department of Clinical Sciences, Section of Rheumatology, Lund University , Malmö, Sweden
| | - O Patschan
- a Department of Urology, Skåne University Hospital, Lund University , Malmö, Sweden
| | - T Hopfgarten
- a Department of Urology, Skåne University Hospital, Lund University , Malmö, Sweden
| | - J Askling
- d Clinical Epidemiology Unit and Rheumatology Unit, Department of Medicine (Solna), Karolinska Institutet , Stockholm, Sweden
| | - L E Kristensen
- c Department of Clinical Sciences, Section of Rheumatology, Lund University , Malmö, Sweden.,e The Parker Institute, Department of Rheumatology, Copenhagen University Hospital , Frederiksberg, Denmark
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