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Hatemi G, Meara A, Ozguler Y, Direskeneli H, Mahr A, Easley E, Gurcan M, Davis T, Gul A, Yazici Y, Zottenberg K, Esatoglu SN, Erer B, Kamali S, Yazici H, Cronholm PF, Merkel PA. Developing a Core Set of Outcome Measures for Behçet Disease: Report from OMERACT 2016. J Rheumatol 2017; 44:1750-1753. [PMID: 28365574 DOI: 10.3899/jrheum.161352] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group has been working toward developing a data-driven core set of outcome measures for use in clinical trials of Behçet's syndrome [Behçet disease (BD)]. This paper summarizes the group's work through OMERACT 2016, discussions during the meeting, and the future research agenda. METHODS Qualitative patient interviews were conducted among 20 patients with BD who have different types of organ involvement. A 3-round Delphi among BD experts and patients was initiated to identify domains, subdomains, and outcomes to be assessed in clinical trials of BD. The results of these studies were discussed during OMERACT 2016 and next steps were planned. RESULTS Patients' perspectives and priorities were identified through qualitative interviews that identified candidate domains and subdomains for inclusion in the Delphi and characterized some shortcomings of the currently used patient-reported outcomes in BD. The first round of the Delphi was completed and several domains or subdomains were endorsed by the experts and/or the patients. Because many more items were endorsed than would be feasible to assess during a clinical trial, rating and ranking of items by physicians and patients was planned as a next critical step. The challenges of assessing specific organ system involvement was also discussed. CONCLUSION The OMERACT Behçet Syndrome Working Group research program will identify core domains for assessment in BD with the goal of developing a core set of outcome measures for use in all trials of BD with the option to incorporate additional outcomes for specific organ involvement.
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Affiliation(s)
- Gulen Hatemi
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Alexa Meara
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Yesim Ozguler
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Haner Direskeneli
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Alfred Mahr
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Ebony Easley
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Mert Gurcan
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Trocon Davis
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Ahmet Gul
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Yusuf Yazici
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Katelyn Zottenberg
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Sinem Nihal Esatoglu
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Burak Erer
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Sevil Kamali
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Hasan Yazici
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Peter F Cronholm
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France.,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Peter A Merkel
- From the Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; Division of Rheumatology, Marmara University Faculty of Medicine; Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Academic Hospital, Istanbul, Turkey; Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Family Medicine and Community Health, University of Pennsylvania; Division of Rheumatology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; New York University School of Medicine, NYU Hospital for Joint Diseases, New York, USA; Department of Internal Medicine, University Paris Diderot, Paris, France. .,G. Hatemi, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine; A. Meara, MD, Clinical Instructor, Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center; Y. Ozguler, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; A. Mahr, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, University Paris Diderot; E. Easley, MPH, Department of Family Medicine and Community Health, University of Pennsylvania; M. Gurcan, Medical student, Istanbul University Cerrahpasa Faculty of Medicine; T. Davis, BA, Department of Family Medicine and Community Health, University of Pennsylvania; A. Gul, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; Y. Yazici, MD, Assistant Professor of Medicine, New York University School of Medicine, NYU Hospital for Joint Diseases; K. Zottenberg, patient-partner; S.N. Esatoglu, MD, Fellow in Rheumatology, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine; B. Erer, MD, Associate Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine; S. Kamali, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine; H. Yazici, MD, Professor of Rheumatology, Academic Hospital; P.F. Cronholm, MD, Associate Professor of Family Medicine, Department of Family Medicine and Community Health, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania.
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